Microbial Etiology of Pyogenic Vertebral Osteomyelitis According to Patient Characteristics

BACKGROUND: It is difficult to select an appropriate empirical antibiotic treatment regimen for patients with culture-negative pyogenic vertebral osteomyelitis (PVO). Having knowledge of the distribution of microorganisms according to patient characteristics can help clinicians make informed choices regarding empirical antibiotics. The aim of this study was to determine the microbial distribution among individuals with PVO according to their demographic and clinical characteristics. METHODS: We reviewed the medical records of patients admitted to our hospital with culture-confirmed PVO between January 2005 and December 2017 and collected data on demographics, underlying diseases, and radiographic and microbiological results. Statistical analysis was performed to identify associations between specific bacteria and specific patient characteristics. RESULTS: A total of 586 patients were included in the study. The prevalence of Staphylococcus aureus infections was higher in young patients than in old patients, while gram-negative bacterial infections and Enterococcus were more prevalent in older patients. Gram-negative bacterial infections were more common in women than in men (32.1% vs 16.4%; P < .05), in patients with cirrhosis than in those without (32.7% vs 21.1%; P < .05), and in patients with a solid tumor than in those without (31.0% vs 20.7%; P < .05). Methicillin-resistant S. aureus infections were more prevalent in patients with chronic renal disease than in those without (34.4% vs 14.7%; P < .05). CONCLUSIONS: The microbial etiology of PVO varies according to patient characteristics. Patient characteristics should thus be considered when choosing empirical antibiotics in patients with culture-negative PVO.