Clinical features of pyogenic vertebral osteomyelitis and factors associated with adverse clinical outcome: a retrospective cohort study

Pyogenic vertebral osteomyelitis (PVO) is an increasingly prevalent disease that poses significant challenges in clinical management. The present study aimed to evaluate the clinical characteristics of PVO and identify the risk factors associated with adverse outcomes. Adult patients diagnosed with PVO at a tertiary education and research hospital in Turkiye between January 2015 and January 2019 were included in this retrospective study. Adverse outcome was defined as the persistence or progression of PVO-related symptoms and signs at the end of treatment. Of the 68 PVO patients included in the study, 41% had a history of vertebral surgery, and 22% had a central venous catheter. Neurological deficit was observed in 47% of the patients. The most commonly isolated pathogen was Staphylococcus aureus (27%). The median duration of parenteral antimicrobial therapy was 42 days (interquartile range, 33–54), and 46% of patients underwent surgical interventions. Adverse outcome was observed in 28% of patients. In multivariate analysis, S. aureus infection, motor weakness, and the presence of a sinus tract were demonstrated as the independent risk factors for adverse outcome. Furthermore, the C-reactive protein (CRP) values at admission and on the 7th day of antimicrobial therapy were shown to be predictive of adverse outcome (≥ 54.5 mg/L and ≥ 38 mg/L, respectively). Independent predictors of adverse outcome in patients with PVO were S. aureus infection, motor weakness, and the presence of a sinus tract. Furthermore, CRP measurement at presentation and on day 7 of antimicrobial therapy was found to contribute to the prediction of adverse outcome.