Infect Chemother.  2019 Sep;51(3):284-294. 10.3947/ic.2019.51.3.284.

Antibiotic Treatment of Vertebral Osteomyelitis caused by Methicillin-Susceptible Staphylococcus aureus: A Focus on the Use of Oral β-lactams

• Oh WS
• Moon C
• Chung JW
• Choo EJ
• Kwak YG
• Kim SH
• Ryu SY
• Park SY
• Kim BN

• KMID: 2459044
• DOI: http://doi.org/10.3947/ic.2019.51.3.284

Abstract

BACKGROUND
Vertebral osteomyelitis (VO) is a rare but serious condition, and a potentially significant cause of morbidity. Methicillin-susceptible Staphylococcus aureus (MSSA) is the most common microorganism in native VO. Long-term administration of parenteral and oral antibiotics with good bioavailability and bone penetration is required for therapy. Use of oral β-lactams against staphylococcal bone and joint infections in adults is not generally recommended, but some experts recommend oral switching with β-lactams. This study aimed to describe the current status of antibiotic therapy and treatment outcomes of oral switching with β-lactams in patients with MSSA VO, and to assess risk factors for treatment failure.
MATERIALS AND METHODS
This retrospective study included adult patients with MSSA VO treated at nine university hospitals in Korea between 2005 and 2014. Treatment failure was defined as infection-related death, microbiological relapse, neurologic deficits, or unplanned surgical procedures. Clinical characteristics and antibiotic therapy in the treatment success and treatment failure groups were compared. Risk factors for treatment failure were identified using the Cox proportional hazards model.
RESULTS
A total of 100 patients with MSSA VO were included. All patients were treated, initially or during antibiotic therapy, with one or more parenteral antibiotics. Sixty-nine patients received one or more oral antibiotics. Antibiotic regimens were diverse and durations of parenteral and oral therapy differed, depending on the patient and the hospital. Forty-two patients were treated with parenteral and/or oral β-lactams for a total duration of more than 2 weeks. Compared with patients receiving parenteral β-lactams only, no significant difference in success rates was observed in patients who received oral β-lactams for a relatively long period. Sixteen patients had treatment failure. Old age (adjusted hazard ratio [HR] 5.600, 95% confidence interval [CI] 1.402 - 22.372, P = 0.015) and failure to improve C-reactive protein levels at follow-up (adjusted HR 3.388, 95% CI 1.168 - 9.829, P = 0.025) were independent risk factors for treatment failure.
CONCLUSION
In the study hospitals, diverse combinations of antibiotics and differing durations of parenteral and oral therapy were used. Based on the findings of this study, we think that switching to oral β-lactams may be safe in certain adult patients with MSSA VO. Since limited data are available on the efficacy of oral antibiotics for treatment of staphylococcal VO in adults, further evaluation of the role of oral switch therapy with β-lactams is needed.

Keyword

Staphylococcus aureus; Vertebral osteomyelitis; Treatment outcome; Beta-Lactams; Oral administration

MeSH Terms

Administration, Oral
Adult
Anti-Bacterial Agents
beta-Lactams
Biological Availability
C-Reactive Protein
Follow-Up Studies
Hospitals, University
Humans
Joints
Korea
Neurologic Manifestations
Osteomyelitis*
Proportional Hazards Models
Recurrence
Retrospective Studies
Risk Factors
Staphylococcus aureus*
Staphylococcus*
Treatment Failure
Treatment Outcome
Anti-Bacterial Agents
C-Reactive Protein
beta-Lactams

Figure

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  Figure 1 Flow diagram for eligibility of cases with vertebral osteomyelitis caused by methicillin-susceptible Staphylococcus aureus. VO, vertebral osteomyelitis; MSSA, methicillin-susceptible Staphylococcus aureus.

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