Hematogenous Pyogenic Vertebral Osteomyelitis: Clinical and microbiological characteristics
Aleksandr Yuryevich Bazarov, Konstantin S Sergeev and Roman V Paskov
Tyumen Regional Clinical Hospital, Russia
Tyumen State Medical University, Russia
: J Spine Neurosurg
Abstract
Statement of the Problem: Hematogenous Pyogenic Vertebral Osteomyelitis (PVO) is a rare and hardly diagnosed disease. The main pathogen of PVO is S. aureus isolated from 20.0 to 84.0%. It is impossible to isolate a pathogen of PVO in 34.3–35.4%. The general effectiveness of biopsy (open or closed) and blood test for sterility reaches 66.0%, and an open biopsy 93.0% of cases. Objective: To analyze clinical picture and composition of pathogens of PVO. Material and Methods: A retrospective monocenter analysis of medical records of patients with PVO at the Tyumen Regional Hospital in 2006–2017 was carried out. The nature of the isolated microflora was studied based on 209 patients: 68 were conservatively treated, and 141 were operated on. Ninety three bacterial strains were isolated from the surgical material in 77 patients, 20 – from aspiration biopsy in 32 patients, 21 – 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%. The main pathogens were Staphylococcus spp. (53.8%). S. aureus (MSSA) was isolated in 35.5%, MRSA in 3.3%. In 26 (12.4%) patients, two or more pathogens were detected. Conclusion: The most common cause of PVO is gram-positive flora with a predominance of S. aureus (38.8%). Anaerobes were identified in 30.6%. 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 for the Cervical Spine Lesions (p=0.003), there is a tendency to an increase in peptostreptococci for the Lumbar Spine (p=0.09). S. aureus is significantly more often isolated in acute form PVO 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.
Biography
Aleksandr Yuryevich Bazarov is an Orthopedic Trauma Surgeon at Tyumen Regional Clinical Hospital, Russia. The main scope of his research and practice interest lies within the sphere of Spine Traumas and Pathologies. Since 2005, he has been treating patients with Pyogenic Vertebral Osteomyelitis from all over the Tyumen region (Russia). More than 90% of such patients go through our hospital. By today, the number of treated patients with Vertebral Osteomyelitis has reached 276 and he has been preparing the results of his work for publication.
