PMID- 34827348
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211130
IS  - 2079-6382 (Print)
IS  - 2079-6382 (Electronic)
IS  - 2079-6382 (Linking)
VI  - 10
IP  - 11
DP  - 2021 Nov 18
TI  - Is There a Difference in Clinical Features, Microbiological Epidemiology and 
      Effective Empiric Antimicrobial Therapy Comparing Healthcare-Associated and 
      Community-Acquired Vertebral Osteomyelitis?
LID - 10.3390/antibiotics10111410 [doi]
LID - 1410
AB  - BACKGROUND: Empiric antibiotic therapy for suspected vertebral osteomyelitis (VO) 
      should be initiated immediately in severely ill patients, and might be necessary 
      for culture-negative VO. The current study aimed to identify differences between 
      community-acquired (CA) and healthcare-associated (HA) VO in terms of clinical 
      presentation, causative pathogens, and antibiotic susceptibility. METHODS: Cases 
      of adult patients with VO treated at a German university orthopaedic trauma 
      center between 2000 and 2020 were retrospectively reviewed. Patient history was 
      used to distinguish between CA and HA VO. Susceptibility of antibiotic regimens 
      was assessed based on antibiograms of the isolated pathogens. RESULTS: A total of 
      155 patients (with a male to female ratio of 1.3; and a mean age of 66.1 +/- 12.4 
      years) with VO were identified. In 74 (47.7%) patients, infections were deemed 
      healthcare-associated. The most frequently identified pathogens were 
      Staphylococcus aureus (HAVO: 51.2%; CAVO: 46.8%), and Coagulase-negative 
      Staphylococci (CoNS, HAVO: 31.7%; CAVO: 21.3%). Antibiograms of 45 patients 
      (HAVO: n = 22; CAVO: n = 23) were evaluated. Significantly more 
      methicillin-resistant isolates, mainly CoNS, were found in the HAVO cohort 
      (27.3%). The highest rate of resistance was found for cefazolin (HAVO: 45.5%; 
      CAVO: 26.1%). Significantly higher rates of resistances were seen in the HAVO 
      cohort for mono-therapies with meropenem (36.4%), piperacillin-tazobactam 
      (31.8%), ceftriaxone (27.3%), and co-amoxiclav (31.8%). The broadest 
      antimicrobial coverage was achieved with either a combination of 
      piperacillin-tazobactam + vancomycin (CAVO: 100.0%; HAVO: 90.9%) or meropenem + 
      vancomycin (CAVO: 100.0%; HAVO: 95.5%). CONCLUSION: Healthcare association is 
      common in VO. The susceptibility pattern of underlying pathogens differs from 
      CAVO. When choosing an empiric antibiotic, combination therapy must be 
      considered.
FAU - Lang, Siegmund
AU  - Lang S
AUID- ORCID: 0000-0003-0459-9092
AD  - Department of Trauma Surgery, University Hospital Regensburg, 
      Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
FAU - Fromming, Astrid
AU  - Fromming A
AD  - Department of Trauma Surgery, University Hospital Regensburg, 
      Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
FAU - Walter, Nike
AU  - Walter N
AD  - Department of Trauma Surgery, University Hospital Regensburg, 
      Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
FAU - Freigang, Viola
AU  - Freigang V
AD  - Department of Trauma Surgery, University Hospital Regensburg, 
      Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
FAU - Neumann, Carsten
AU  - Neumann C
AD  - Department of Trauma Surgery, University Hospital Regensburg, 
      Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
FAU - Loibl, Markus
AU  - Loibl M
AD  - Department of Trauma Surgery, University Hospital Regensburg, 
      Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
AD  - Department of Spine Surgery, Schulthess Clinic, Lenghalde 2, 8008 Zurich, 
      Switzerland.
FAU - Ehrenschwender, Martin
AU  - Ehrenschwender M
AD  - Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, 
      Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
FAU - Alt, Volker
AU  - Alt V
AUID- ORCID: 0000-0003-0208-4650
AD  - Department of Trauma Surgery, University Hospital Regensburg, 
      Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
FAU - Rupp, Markus
AU  - Rupp M
AD  - Department of Trauma Surgery, University Hospital Regensburg, 
      Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
LA  - eng
PT  - Journal Article
DEP - 20211118
PL  - Switzerland
TA  - Antibiotics (Basel)
JT  - Antibiotics (Basel, Switzerland)
JID - 101637404
PMC - PMC8615006
OTO - NOTNLM
OT  - antimicrobial resistance
OT  - coagulase-negative staphylococci
OT  - epidemiology
OT  - healthcare-associated infections
OT  - spine
OT  - systemic antibiotic therapy
OT  - treatment
OT  - vertebral osteomyelitis
COIS- The authors declare no conflict of interest.
EDAT- 2021/11/28 06:00
MHDA- 2021/11/28 06:01
PMCR- 2021/11/18
CRDT- 2021/11/27 01:02
PHST- 2021/10/18 00:00 [received]
PHST- 2021/11/12 00:00 [revised]
PHST- 2021/11/15 00:00 [accepted]
PHST- 2021/11/27 01:02 [entrez]
PHST- 2021/11/28 06:00 [pubmed]
PHST- 2021/11/28 06:01 [medline]
PHST- 2021/11/18 00:00 [pmc-release]
AID - antibiotics10111410 [pii]
AID - antibiotics-10-01410 [pii]
AID - 10.3390/antibiotics10111410 [doi]
PST - epublish
SO  - Antibiotics (Basel). 2021 Nov 18;10(11):1410. doi: 10.3390/antibiotics10111410.