Selection of an appropriate empiric antibiotic regimen in hematogenous vertebral osteomyelitis.

Abstract

BACKGROUND:

Empiric antibiotic therapy for suspected hematogenous vertebral osteomyelitis (HVO) should be initiated immediately in seriously ill patients and may be required in those with negative microbiological results. The aim of this study was to inform the appropriate selection of empiric antibiotic regimens for the treatment of suspected HVO by analyzing antimicrobial susceptibility of isolated bacteria from microbiologically proven HVO.

METHOD:

We conducted a retrospective chart review of adult patients with microbiologically proven HVO in five tertiary-care hospitals over a 7-year period. The appropriateness of empiric antibiotic regimens was assessed based on the antibiotic susceptibility profiles of isolated bacteria.

RESULTS:

In total, 358 cases of microbiologically proven HVO were identified. The main causative pathogens identified were methicillin-susceptible Staphylococcus aureus (33.5%), followed by methicillin-resistant S. aureus (MRSA) (24.9%), Enterobacteriaceae (19.3%), and Streptococcus species (11.7%). Extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and anaerobes accounted for only 1.7% and 1.4%, respectively, of the causative pathogens. Overall, 73.5% of isolated pathogens were susceptible to levofloxacin plus rifampicin, 71.2% to levofloxacin plus clindamycin, and 64.5% to amoxicillin-clavulanate plus ciprofloxacin. The susceptibility to these oral combinations was lower in cases of healthcare-associated HVO (52.6%, 49.6%, and 37.6%, respectively) than in cases of community-acquired HVO (85.8%, 84.0%, and 80.4%, respectively). Vancomycin combined with ciprofloxacin, ceftriaxone, ceftazidime, or cefepime was similarly appropriate (susceptibility rates of 93.0%, 94.1%, 95.8%, and 95.8%, respectively).

CONCLUSIONS:

Based on our susceptibility data, vancomycin combined with a broad-spectrum cephalosporin or fluoroquinolone may be appropriate for empiric treatment of HVO. Fluoroquinolone-based oral combinations may be not appropriate due to frequent resistance to these agents, especially in cases of healthcare-associated HVO.

• Authors: Ki-Ho Park, Dong Youn Kim, Yu-Mi Lee, Mi Suk Lee, Kyung-Chung Kang, Jung-Hee Lee, Seong Yeon Park, Chisook Moon, Yong Pil Chong, Sung-Han Kim, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Jun Hee Woo, Byung-Han Ryu, In-Gyu Bae, Oh-Hyun Cho
• Journal: PloS one (PLoS One) Vol. 14 Issue 2 Pg. e0211888 ( 2019) ISSN: 1932-6203 [Electronic] United States
• PMID: 30735536 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Clindamycin
• Ciprofloxacin
• Levofloxacin
• Vancomycin
• Amoxicillin-Potassium Clavulanate Combination
• beta-Lactamases
• Rifampin

Topics

• Aged
• Amoxicillin-Potassium Clavulanate Combination (therapeutic use)
• Anti-Bacterial Agents (therapeutic use)
• Bacterial Infections (diagnosis, drug therapy, microbiology, pathology)
• Ciprofloxacin (therapeutic use)
• Clindamycin (therapeutic use)
• Drug Therapy, Combination
• Empirical Research
• Enterobacteriaceae (drug effects, growth & development, pathogenicity)
• Female
• Gene Expression
• Humans
• Levofloxacin (therapeutic use)
• Male
• Methicillin-Resistant Staphylococcus aureus (drug effects, growth & development, pathogenicity)
• Microbial Sensitivity Tests
• Middle Aged
• Osteomyelitis (diagnosis, drug therapy, microbiology, pathology)
• Retrospective Studies
• Rifampin (therapeutic use)
• Spine (drug effects, microbiology, pathology)
• Streptococcus (drug effects, growth & development, pathogenicity)
• Vancomycin (therapeutic use)
• beta-Lactamases (genetics, metabolism)