Hematogenous pyogenic vertebral osteomyelitis: clinical and microbiological characteristics
A. Yu. Bazarov,
I. A. Lebedev,
A. L. Barinov,
M. A. Rebyatnikova,
A. O. Faryon,
R. V. Paskov,
K. S. Sergeyev,
V. M. Osintsev https://doi.org/10.14531/ss2020.1.102-109
Abstract
Objective. To analyze clinical picture and composition of pathogens of hematogenous pyogenic vertebral osteomyelitis (PVO) based on the records of a regional clinic admitting patients with this disease.
Material and Methods. A retrospective monocenter analysis of medical records of patients who underwent treatment for hematogenous PVO at the Tyumen Regional Clinical Hospital No. 2 in 2006–2017 was carried out. The nature of the isolated microflora was studied based on 209 inpatient medical records. Out of them, 68 patients were conservatively treated, and 141 were operated on. Ninety three bacterial strains were isolated from the surgical material in 77 patients, 20 strains – from aspiration biopsy in 32 patients, 21 strains – from blood in 20 patients.
Results. The causative agent of PVO was identified in 117 (56.0 %) patients including gram-positive flora in 56.3 % of cases. The main pathogens were Staphylococcus spp. (53.8 %). Oxacillin-sensitive S. aureus (MSSA) was isolated in 35.5 % of cases, its resistant form (MRSA) in 3.3 %. In 26 (12.4 %) patients, two or more pathogens were detected with a predominance of staphylococcal flora.
Conclusion. The most common cause of hematogenous PVO is gram-positive flora with a predominance of S. aureus (38.8 %). Anaerobes were identified in 30.6 % of cases. In 26 (12.4 %) cases, more than one pathogen was isolated. There were no significant differences in the form of the disease with gram-positive and gram-negative flora, and polymicrobial lesions (p = 0.498). S. aureus is more common in lesions of the cervical spine in comparison with the thoracic (p = 0.003) and lumbar (p = 0.001) spine. There is a tendency to an increase in peptostreptococci in lesions of the lumbar spine (p = 0.09). S. aureus is significantly more often isolated in acute in acute form of the disease than in subacute (p = 0.009) and chronic (p = 0.012) forms, and peptostreptococci – in subacute (p = 0.001) and chronic (p = 0.003) forms of the disease.
Material and Methods. A retrospective monocenter analysis of medical records of patients who underwent treatment for hematogenous PVO at the Tyumen Regional Clinical Hospital No. 2 in 2006–2017 was carried out. The nature of the isolated microflora was studied based on 209 inpatient medical records. Out of them, 68 patients were conservatively treated, and 141 were operated on. Ninety three bacterial strains were isolated from the surgical material in 77 patients, 20 strains – from aspiration biopsy in 32 patients, 21 strains – from blood in 20 patients.
Results. The causative agent of PVO was identified in 117 (56.0 %) patients including gram-positive flora in 56.3 % of cases. The main pathogens were Staphylococcus spp. (53.8 %). Oxacillin-sensitive S. aureus (MSSA) was isolated in 35.5 % of cases, its resistant form (MRSA) in 3.3 %. In 26 (12.4 %) patients, two or more pathogens were detected with a predominance of staphylococcal flora.
Conclusion. The most common cause of hematogenous PVO is gram-positive flora with a predominance of S. aureus (38.8 %). Anaerobes were identified in 30.6 % of cases. In 26 (12.4 %) cases, more than one pathogen was isolated. There were no significant differences in the form of the disease with gram-positive and gram-negative flora, and polymicrobial lesions (p = 0.498). S. aureus is more common in lesions of the cervical spine in comparison with the thoracic (p = 0.003) and lumbar (p = 0.001) spine. There is a tendency to an increase in peptostreptococci in lesions of the lumbar spine (p = 0.09). S. aureus is significantly more often isolated in acute in acute form of the disease than in subacute (p = 0.009) and chronic (p = 0.012) forms, and peptostreptococci – in subacute (p = 0.001) and chronic (p = 0.003) forms of the disease.
About the Authors
A. Yu. Bazarov
Tyumen Regional Clinical Hospital No. 2
Russian Federation
Russian Federation
Aleksandr Yuryevich Bazarov, MD, PhD, orthopedic trauma surgeon at the Trauma and Orthopedic Department No. 3, Head of Surgical Unit
75 Melnikaite str., Tyumen, 625039, Russia
I. A. Lebedev
Tyumen State Medical University
Russian Federation
Russian Federation
Ilya Arkadyevich Lebedev, DMSc, Associate Professor of the Department of Neurology with a course of neurosurgery
54 Odesskaya str., Tyumen, 625023, Russia
A. L. Barinov
Tyumen Regional Clinical Hospital No. 2
Russian Federation
Russian Federation
Aleksandr Leonidovich Barinov, MD, microbiologist, Head of the Microbiological Laboratory
75 Melnikaite str., Tyumen, 625039, Russia
M. A. Rebyatnikova
Tyumen Regional Clinical Hospital No. 2
Russian Federation
Russian Federation
Marina Alekseyevna Rebyatnikova, MD, PhD, clinical pharmacologist
75 Melnikaite str., Tyumen, 625039, Russia
A. O. Faryon
Tyumen Regional Clinical Hospital No. 2
Russian Federation
Russian Federation
Aleksey Olegovich Faryon, MD, PhD, orthopedic traumatologist. Head of Traumatology and Orthopedic Department No.1
75 Melnikaite str., Tyumen, 625039, Russia
R. V. Paskov
Tyumen Regional Clinical Hospital No. 2;
Tyumen State Medical University
Russian Federation
Russian Federation
Roman Vladimirovich Paskov, DMSc, orthopedic traumatologist, Head physician; Professor of the Department of Traumatology and Orthopedics with a course in pediatric traumatology
75 Melnikaite str., Tyumen 625039, Russia;
54 Odesskaya str., Tyumen, 625023, Russia
K. S. Sergeyev
Tyumen State Medical University
Russian Federation
Russian Federation
Konstantin Sergeyevich Sergeyev, MD, DMsc, Prof, Head of the Department of Traumatology and Orthopedics with a course in Pediatric Traumatology
54 Odesskaya str., Tyumen, 625023, Russia
V. M. Osintsev
Tyumen State Medical University
Russian Federation
Russian Federation
Vladislav Mikhailovich Osintsev, MD, PhD, Associate Professor of the Department of Traumatology and Orthopedics with a course in Pediatric Traumatology
54 Odesskaya str., Tyumen, 625023, Russia
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Review
For citations:
Bazarov A.Yu., Lebedev I.A., Barinov A.L., Rebyatnikova M.A., Faryon A.O., Paskov R.V., Sergeyev K.S., Osintsev V.M. Hematogenous pyogenic vertebral osteomyelitis: clinical and microbiological characteristics. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2020;17(1):102-109. https://doi.org/10.14531/ss2020.1.102-109
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