Schindler Melanie, Walter Nike, Reinhard Jan, Pagano Stefano, Szymski Dominik, Alt Volker, Rupp Markus, Lang Siegmund
Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany.
Department of Orthopaedic Surgery, University Hospital of Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany.
Front Surg. 2024 May 21;11:1357318. doi: 10.3389/fsurg.2024.1357318. eCollection 2024.
Pyogenic vertebral osteomyelitis (VO) represents a clinical challenge and is linked to substantial morbidity and mortality. This study aimed to examine mortality as well as potential risk factors contributing to in-hospital mortality among patients with VO.
This retrospective analysis involved patients receiving treatment for VO at University Regensburg in Germany from January 1, 2000, to December 3, 2020. It included in-hospital mortality rate, comorbidities and pathogens. Patients were identified using ICD-10 diagnosis codes: M46.2, M46.3, M46.4, and M46.5. Kaplan-Meier probability plots and odds ratios (OR) for mortality were calculated.
Out of the total cohort of 155 patients with VO, 53 patients (34.1%) died during a mean follow-up time of 87.8 ± 70.8 months. The overall mortality was 17.2% at one year, 19.9% at two years and 28.3% at five years. Patients with congestive heart failure ( = 0.005), renal disease ( < 0.001), symptoms of paraplegia ( = 0.029), and sepsis ( = 0.006) demonstrated significantly higher overall mortality rates. In 56.1% of cases, pathogens were identified, with and other unidentified pathogens being the most common. Renal disease (OR 1.85) and congestive heart failure (OR 1.52) were identified as significant risk factors.
Early assessment of the specific risk factors for each patient may prove beneficial in the management and treatment of VO to reduce the risk of mortality. These findings demonstrate the importance of close monitoring of VO patients with underlying chronic organ disease and early identification and treatment of sepsis. Prioritizing identification of the exact pathogens and antibiotic sensitivity testing can improve outcomes for patients in this high-risk group.
化脓性脊椎骨髓炎（VO）是一项临床挑战，与显著的发病率和死亡率相关。本研究旨在调查VO患者的死亡率以及导致住院死亡率的潜在风险因素。
这项回顾性分析纳入了2000年1月1日至2020年12月3日在德国雷根斯堡大学接受VO治疗的患者。分析内容包括住院死亡率、合并症和病原体。使用ICD-10诊断编码（M46.2、M46.3、M46.4和M46.5）识别患者。计算Kaplan-Meier生存概率图和死亡率的比值比（OR）。
在155例VO患者的总队列中，53例患者（34.1%）在平均87.8±70.8个月的随访期内死亡。1年时的总死亡率为17.2%，2年时为19.9%，5年时为28.3%。充血性心力衰竭患者（P = 0.005）、肾病患者（P < 0.001）、截瘫症状患者（P = 0.029）和脓毒症患者（P = 0.006）的总死亡率显著更高。在56.1%的病例中鉴定出病原体，金黄色葡萄球菌和其他未鉴定的病原体最为常见。肾病（OR 1.85）和充血性心力衰竭（OR 1.52）被确定为显著的风险因素。
对每位患者的特定风险因素进行早期评估可能有助于VO的管理和治疗，以降低死亡风险。这些发现表明密切监测患有潜在慢性器官疾病的VO患者以及早期识别和治疗脓毒症的重要性。优先确定确切病原体并进行抗生素敏感性测试可以改善这一高危组患者的治疗结果。
