Orthopedic Infectious Diseases Online Library
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Background Native vertebral osteomyelitis (NVO) is a life-threatening spinal infection with rising incidence and significant morbidity. Despite its growing burden, long-term data on clinical characteristics, management trends, and outcomes remain limited. Methods We conducted a 26-year multicenter retrospective cohort study of adults (≥18 years) diagnosed with NVO at Mayo Clinic sites between 1999 and 2024. Demographic, microbiologic, treatment, and outcome data were analyzed across five time periods. Predictors of treatment failure were assessed using a multivariable competing risk model. Results Among 1255 patients (median age 67; 66% male), lumbosacral involvement was most common (65%), and 21% had multilevel involvement. Pathogens were identified in 77%, most commonly Staphylococcus aureus (49%; Methicillin-susceptible S. aureus 37%, methicillin-resistant S. aureus 13%). Over time from 1999–2004 to 2020–2024, Gram-negative bacilli increased from 6% to 14% (P = .048). Comorbidities including chronic kidney disease (10% to 21%), active chemotherapy (6% to 11%), and immunosuppression (8% to 17%) increased significantly. Additionally, 1-year treatment failure declined (16% to 10%). In multivariable analysis, diabetes mellitus (subdistribution hazard ratio [sHR] 1.92, 95% CI 1.18–3.13) and multilevel involvement (sHR 1.67, 95% CI 1.17–2.38) were associated with increased incidence of treatment failure, while concurrent infections (sHR 0.57, 95% CI 0.37–0.87) and higher Charlson Comorbidity Index (sHR 0.62, 95% CI 0.43–0.90) were associated with lower failure. Conclusions This large multicenter cohort highlights increasing host complexity, shifting microbiology, and predictors of failure, emphasizing the importance of early risk stratification and tailored strategies, such as multidisciplinary evaluation and close follow-up of high-risk patients to improve outcomes.
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Background: Early diagnosis and treatment of osteomyelitis is essential to prevent potential complications including sepsis, extensive bone resection, amputation, and death. Despite current treatment strategies for management of osteomyelitis, recurrence rates reported in the literature are upwards of 25 %. Current evidence comparing the efficacy of differing surgical treatments of osteomyelitis is inconclusive. The purpose of this study is to compare rates of re-debridement and amputation in patients who receive either debridement alone or debridement with placement of local antibiotic delivery systems as initial treatment for lower extremity long bone osteomyelitis. Methods: A retrospective cohort study was performed to investigate complication rates after surgical treatment methods for osteomyelitis of the femur and tibia. The rates of re-debridement and amputation were compared in patients who received either debridement alone or debridement with placement of local antibiotic delivery systems. Results: This study reports 73 % lower rates of re-debridement after debridement and local antibiotic delivery in tibial osteomyelitis, and 83 % lower rates of re-debridement after debridement and placement of local antibiotic delivery systems in femoral osteomyelitis compared to debridement alone. There was no significant difference in amputation rates between treatment groups for either tibial (7.4 vs 5.7 %; OR: 1.31; 95 % CI, 0.92-1.87) or femoral osteomyelitis (2.4 vs 1.4 %; OR: 1.65; 95 % CI, 0.71-4.01). Conclusion: There was a significantly decreased likelihood of re-debridement for patients who underwent initial treatment with combined debridement and placement of antibiotic delivery systems compared to debridement alone. Providers may consider this when comparing treatment options for their patients with lower extremity osteomyelitis.
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- Journal Article (2)