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Management of vertebral osteomyelitis over an eight-year period: The UDIPROVE (UDIne PROtocol on VErtebral osteomyelitis).
Int J Infect Dis 2019; 89:116-121IJ

Abstract

OBJECTIVES

Vertebral osteomyelitis (VO) is a compelling clinical entity for clinicians because of its insidious and indolent course, which makes diagnosis difficult.

METHODS

All patients with a suspected diagnosis of VO were analyzed over an 8-year period (January 2009 to January 2017). The UDIPROVE protocol (UDIne PROtocol on VErtebral osteomyelitis) was applied in all cases. The primary endpoint was the performance of the UDIPROVE protocol to obtain the causal bacteria of infection.

RESULTS

During the study period, 133 episodes of confirmed VO were observed. The etiology of infection was obtained in 73.6% of cases: 70.5% were gram-positive, 16.3% were gram-negative, and 13.2% were mycobacteria. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed that for tubercular VO, the median standard uptake value (SUV) was higher when compared with VO caused by other bacteria. Clinical cure at the end of therapy was reported in 85.7% of patients. Previous antimicrobial therapy and a delay of more than 5 days in performing biopsy were associated with an undiagnosed etiology of VO. Targeted antibacterial therapy and follow-up with FDG-PET/CT were associated with clinical cure at the end of therapy, while the involvement of more than two vertebrae and inadequate drainage were associated with failure.

CONCLUSIONS

Rigorous application of the UDIPROVE protocol allowed the causative pathogens of VO to be obtained - at about twice the rate reported in the literature. The use of FDG-PET/CT for the follow-up of infection was more reliable when compared to magnetic resonance imaging (MRI).

Authors+Show Affiliations

Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.Division of Vascular and Interventional Radiology, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.Microbiology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, Genoa and Hospital Policlinico San Martino - IRCCS, Genoa, Italy. Electronic address: Matteo.Bassetti@hsanmartino.it.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31629078

Citation

Russo, Alessandro, et al. "Management of Vertebral Osteomyelitis Over an Eight-year Period: the UDIPROVE (UDIne PROtocol On VErtebral Osteomyelitis)." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 89, 2019, pp. 116-121.
Russo A, Graziano E, Carnelutti A, et al. Management of vertebral osteomyelitis over an eight-year period: The UDIPROVE (UDIne PROtocol on VErtebral osteomyelitis). Int J Infect Dis. 2019;89:116-121.
Russo, A., Graziano, E., Carnelutti, A., Sponza, M., Cadeo, B., Sartor, A., ... Bassetti, M. (2019). Management of vertebral osteomyelitis over an eight-year period: The UDIPROVE (UDIne PROtocol on VErtebral osteomyelitis). International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 89, pp. 116-121. doi:10.1016/j.ijid.2019.10.010.
Russo A, et al. Management of Vertebral Osteomyelitis Over an Eight-year Period: the UDIPROVE (UDIne PROtocol On VErtebral Osteomyelitis). Int J Infect Dis. 2019 Oct 17;89:116-121. PubMed PMID: 31629078.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of vertebral osteomyelitis over an eight-year period: The UDIPROVE (UDIne PROtocol on VErtebral osteomyelitis). AU - Russo,Alessandro, AU - Graziano,Elena, AU - Carnelutti,Alessia, AU - Sponza,Massimo, AU - Cadeo,Barbara, AU - Sartor,Assunta, AU - Righi,Elda, AU - Bassetti,Matteo, Y1 - 2019/10/17/ PY - 2019/08/13/received PY - 2019/10/07/revised PY - 2019/10/11/accepted PY - 2019/10/20/pubmed PY - 2019/10/20/medline PY - 2019/10/20/entrez KW - C-reactive protein KW - FDG-PET/CT KW - MRI KW - Vertebral biopsy KW - Vertebral osteomyelitis SP - 116 EP - 121 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int. J. Infect. Dis. VL - 89 N2 - OBJECTIVES: Vertebral osteomyelitis (VO) is a compelling clinical entity for clinicians because of its insidious and indolent course, which makes diagnosis difficult. METHODS: All patients with a suspected diagnosis of VO were analyzed over an 8-year period (January 2009 to January 2017). The UDIPROVE protocol (UDIne PROtocol on VErtebral osteomyelitis) was applied in all cases. The primary endpoint was the performance of the UDIPROVE protocol to obtain the causal bacteria of infection. RESULTS: During the study period, 133 episodes of confirmed VO were observed. The etiology of infection was obtained in 73.6% of cases: 70.5% were gram-positive, 16.3% were gram-negative, and 13.2% were mycobacteria. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed that for tubercular VO, the median standard uptake value (SUV) was higher when compared with VO caused by other bacteria. Clinical cure at the end of therapy was reported in 85.7% of patients. Previous antimicrobial therapy and a delay of more than 5 days in performing biopsy were associated with an undiagnosed etiology of VO. Targeted antibacterial therapy and follow-up with FDG-PET/CT were associated with clinical cure at the end of therapy, while the involvement of more than two vertebrae and inadequate drainage were associated with failure. CONCLUSIONS: Rigorous application of the UDIPROVE protocol allowed the causative pathogens of VO to be obtained - at about twice the rate reported in the literature. The use of FDG-PET/CT for the follow-up of infection was more reliable when compared to magnetic resonance imaging (MRI). SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/31629078/Management_of_vertebral_osteomyelitis_in_an_8-year_period:_the_UDIPROVE_(UDIne_PROtocol_on_VErtebral_osteomyelitis) L2 - https://linkinghub.elsevier.com/retrieve/pii/S1201-9712(19)30403-5 DB - PRIME DP - Unbound Medicine ER -