Vertebral osteomyelitis in patients with an underlying malignancy or chronic kidney disease - who is at higher risk for adverse outcome?

Dorothee Jochimsen; Ayla Yagdiran; Charlotte Meyer-Schwickerath; Krishnan Sircar; Nikolaus Kernich; Peer Eysel; Carolyn Weber; Norma Jung

doi:10.1007/s15010-024-02451-2

Vertebral osteomyelitis in patients with an underlying malignancy or chronic kidney disease - who is at higher risk for adverse outcome?

Infection. 2024 Dec 21. doi: 10.1007/s15010-024-02451-2. Online ahead of print.

Authors

Dorothee Jochimsen¹, Ayla Yagdiran², Charlotte Meyer-Schwickerath³, Krishnan Sircar², Nikolaus Kernich², Peer Eysel², Carolyn Weber⁴, Norma Jung³

Affiliations

¹ Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany. dorothee.jochimsen@uk-koeln.de.
² Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany.
³ Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany.
⁴ Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany.

PMID: 39708242
DOI: 10.1007/s15010-024-02451-2

Abstract

Purpose: Patients with vertebral osteomyelitis (VO) and comorbidities, notably chronic kidney disease (CKD), are at risk of early mortality. The aim of this study was to compare characteristics and outcomes of VO patients with an underlying malignancy (ONCO) to VO patients with CKD and VO patients without comorbidities (CONTROL).

Methods: We performed a retrospective analysis of data which was prospectively collected between 2008 and 2020. Primary outcome was treatment failure defined as death and/or recurrence of VO within one year.

Results: 241 VO patients (ONCO = 56; CKD = 47; CONTROL = 138) were analysed. Treatment failure occurred in 26% of ONCO and 45% of CKD patients. Staphylococcus aureus was the most common causative pathogen in the CKD (57%) and CONTROL group (43%). ONCO patients showed a broader distribution of common VO-causing pathogens, with coagulase-negative staphylococci (CoNS) accounting for the highest proportion of causative bacteria (27%). Nevertheless, S.aureus was associated with a significantly higher risk of treatment failure in VO ONCO patients.

Conclusion: Treatment failure in VO CKD patients was twice as high as in VO ONCO patients. However, both groups showed high treatment failure rates. CoNS should be considered when starting empirical antibiotic treatment in VO ONCO patients. Moreover, oncological patients with VO caused by S.aureus should be monitored closely.

Keywords: 1-year-mortality; Chronic kidney disease; CoNS; Coagulase-negative staphylococci; Malignancy; Malignant disease; Recurrence; S.aureus; Spondylodiscitis; Staphylococcus aureus; Treatment failure; Vertebral osteomyelitis.