Clinical Complexity in Native Vertebral Osteomyelitis: Exploring the Role of Rurality—A Retrospective Cohort Study

Introduction: Native vertebral osteomyelitis (NVO) is an uncommon infection whose nonspecific presentation frequently delays diagnosis and treatment. Rurality is a potentially relevant but under-researched factor. This study aimed to identify factors independently associated with NVO-related complications at admission, with particular emphasis on rurality, and to describe the cohort’s clinical, etiological, and therapeutic profile. Material and Methods: We conducted an observational, retrospective cohort study of 67 consecutive adults with NVO admitted to the University Hospital of Salamanca between 2018 and 2023. Rurality was defined by primary healthcare zone of residence; nursing home residents formed a separate group. The primary outcome was the presence of at least one NVO-related complication at admission. A multivariable logistic regression model including age, sex, rurality, and multimorbidity was fitted, followed by two sensitivity analyses. Results: NVO-related complications occurred in 56.7% of patients and were more frequent among rural than non-rural patients (73.1% vs. 46.3%; p = 0.031). In the multivariable analysis, rurality (aOR = 4.88; 95% CI, 1.44–16.47; p = 0.011) and multimorbidity (aOR = 3.42; 95% CI, 1.00–11.65; p = 0.049) were independently associated with complications. The association between rurality and NVO-related complications remained consistent across both sensitivity analyses, although its magnitude was imprecise. Conclusions: Rurality may represent a relevant factor in the clinical course of NVO. Further investigation is required.