Wern Johan, Söderquist Bo, Tevell Staffan
Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden.
School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Eur J Clin Microbiol Infect Dis. 2025 May 28. doi: 10.1007/s10096-025-05176-8.
International guidelines for Staphylococcus aureus vertebral osteomyelitis recommend 6 weeks of treatment, including oral follow-up using antibiotics with high bioavailability such as a fluoroquinolone/rifampicin combination. Oral flucloxacillin is not recommended due to low bioavailability and scarce evidence. However, flucloxacillin as oral follow-up treatment is common practice in Sweden based on favourable clinical experience, good tolerability, few interactions, and low ecological impact. Our aim was to review a single-centre experience of S. aureus vertebral osteomyelitis, with focus on flucloxacillin treatment.
A single-centre retrospective cohort of patients with Staphylococcus aureus vertebral osteomyelitis (n = 40) was identified between 2010 and 2016. Patients were further stratified by antibiotic treatment strategy with focus on oral flucloxacillin therapy (n = 24). Primary outcomes were relapse or death within 12 months of treatment initiation, and antibiotic-related adverse effects during treatment.
Methicillin-susceptible S. aureus (MSSA) caused 38 of the infections (95%), and five patients (13%) died, all in-hospital. Flucloxacillin was used for at least 75% of the oral treatment duration in 24 patients (60%). Median antibiotic treatment duration among these patients was 125.5 days (IQR 95-182), 109 days (IQR 76-149) of which comprised oral antibiotics. There were two relapses and two deaths among the patients treated predominantly with flucloxacillin, resulting in a composite clinical cure rate of 83% (20 of 24).
Prolonged oral flucloxacillin administration could be a potential treatment option for MSSA vertebral osteomyelitis. A prospective study of optimal treatment duration and dosing strategies for flucloxacillin in vertebral osteomyelitis is warranted.
金黄色葡萄球菌性脊椎骨髓炎的国际指南推荐进行6周治疗，包括使用生物利用度高的抗生素（如氟喹诺酮/利福平组合）进行口服后续治疗。由于生物利用度低且证据不足，不推荐口服氟氯西林。然而，基于良好的临床经验、良好的耐受性、较少的相互作用和较低的生态影响，氟氯西林作为口服后续治疗在瑞典是常见的做法。我们的目的是回顾单中心金黄色葡萄球菌性脊椎骨髓炎的经验，重点是氟氯西林治疗。
确定了2010年至2016年间单中心金黄色葡萄球菌性脊椎骨髓炎患者的回顾性队列（n = 40）。患者根据抗生素治疗策略进一步分层，重点是口服氟氯西林治疗（n = 24）。主要结局是治疗开始后12个月内的复发或死亡，以及治疗期间与抗生素相关的不良反应。
甲氧西林敏感金黄色葡萄球菌（MSSA）引起了38例感染（95%），5例患者（13%）死亡，均为院内死亡。24例患者（60%）在至少75%的口服治疗期间使用了氟氯西林。这些患者的抗生素治疗中位持续时间为125.5天（IQR 95 - 182），其中109天（IQR 76 - 149）为口服抗生素。主要接受氟氯西林治疗的患者中有2例复发和2例死亡，综合临床治愈率为83%（24例中的20例）。
长期口服氟氯西林给药可能是MSSA性脊椎骨髓炎的一种潜在治疗选择。有必要对氟氯西林在脊椎骨髓炎中的最佳治疗持续时间和给药策略进行前瞻性研究。
