A PDF file should load here. If you do not see its contents
the file may be temporarily unavailable at the journal website
or you do not have a PDF plug-in installed and enabled in your browser.
Alternatively, you can download the file locally and open with any standalone PDF reader:
http://www.aricjournal.com/content/pdf/2047-2994-2-S1-P199.pdf
P199: Clinical characteristics and therapeutic outcomes of hematogenous vertebral osteomyelitis caused by methicillin-resistant Staphylococcus aureus
Lee et al. Antimicrobial Resistance and Infection Control
P199: Clinical characteristics and therapeutic outcomes of hematogenous vertebral osteomyelitis caused by methicillin-resistant Staphylococcus aureus
MS Lee 1
KH Park 0 1
MH Jung 1
YS Kim 0
0 Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea, Republic Of
1 Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Korea , Republic Of
-
From 2nd International Conference on Prevention and Infection Control (ICPIC 2013)
Geneva, Switzerland. 25-28 June 2013
Introduction
Hematogenous vertebral osteomyelitis (HVO) caused by
methicillin-resistant S. aureus (MRSA) has increased in
recent years. Little information is available regarding the
clinical characteristics and outcomes of patients with
HVO caused by MRSA, compared with patients with
HVO caused by methicillin-susceptible S. aureus (MSSA).
Methods
All patients diagnosed with S. aureus (SA) HVO from
January 2005 to December 2011 were included in the
study. Clinical features and outcomes of MRSA HVO
were evaluated compared with MSSA HVO. Molecular
and microbiological characteristics of the MRSA isolates
were determined.
Results
Of the 139 patients with SA HVO, MRSA caused 62
(44.6%) cases. Patients infected with MRSA were more
frequently of hospital-onset (35.5 vs. 13.0, P = .002) than
MSSA-infected patients. Based on clinical and
microbiological evaluation, a potential portal of entry for SA HVO
was identified in 61 patients (43.9%). Intravenous venous
catheters were more likely to be the origin in MRSA than
in MSSA cases (46.7% vs. 22.6%, P = .048). The mortality
rates for MRSA and MSSA HVO were similar (21.0% vs.
19.5%; P = .83). Longer duration of bacteremia (mean 10.1
vs. 3.1 days; P < .001), longer hospital stay (median 69 vs.
52 days; P = .001), and more frequent relapse (16.1% vs.
4.3%; P = .03) were observed among MRSA cases. Among
the MRSA cases, relapse rates were lower in patients with
a longer duration of antibiotic therapy: 41.7% (46 weeks),
25.0% (68 weeks), and 5.6% (8 weeks) (P = .007).
Bacteremia was more likely to persist for 7 days in patients with
an initial vancomycin trough <15 mg/L than in those with
an initial trough 15 mg/L (79.3% vs. 20.0%; P = .001). A
community-associated MRSA strain, specifically
ST72MRSA-SCCmecIV, was responsible for 70.8% of
community-onset infections and 12.5% of hospital-onset infections.
Conclusion
MRSA HVO was associated with longer duration of
bacteremia, longer hospital stay, and more frequent relapse
compared to MSSA HVO. Our data indicate that
antibiotic therapy for at least 8 weeks and targeting an
initial vancomycin trough of 15 mg/L benefit patients
with MRSA HVO. Community-associated MRSA strain
was responsible for substantial proportion of
community-onset MRSA HVO.
Disclosure of interest
None declared
(...truncated)