Objective: The clinical significance of vertebral osteomyelitis (VO) and infectious endocarditis (IE) co-infection is unclear. This study investigates the rate, clinical features and outcome of vertebral osteomyelitis with and without concomitant infectious endocarditis.
Methods: A retrospective study of all cases of osteomyelitis with spinal imaging (n=176), from January 2007 to April 2013, who were diagnosed as vertebral osteomyelitis. Sixty-two patients with spontaneous vertebral osteomyelitis (VO) were identified after excluding post-surgical, decubitus ulcers and spinal metastases. Seventeen (27%) were identified with concomitant infectious endocarditis (IE).
Results: All patients presented with back pain and 59% were diagnosed with IE subsequent to VO. Distinguishing features among the co-infection group include the increased use of TEE (94% vs 58%, p=0.004), predisposing cardiac conditions (59% vs 16%, p= 0.001) and gram-positive bacteremia, of which Streptococcus sp. and Enterococcus sp. were more common (35% vs 11%, p=0.026). Adverse neurologic events were significantly increased in the co-infection group (59% vs 22%, p=0.006). On transesophageal echocardiography, 88% of co-infection patients had highly mobile vegetations, 9 of which measured 10mm or more. The overall mortality was 41% and 29% in the co-infection and lone VO groups, respectively (p=0.356). One-year mortality was identical for both groups at 24%, (p=0.999) and higher than previously reported (11.3% for lone VO)1.
Conclusions: Patients with VO, in which IE is not excluded, are at increased risk for adverse neurologic events and mortality. The prompt diagnosis of IE, and associated high-risk features that may benefit from surgical intervention, require early evaluation by transesophageal echocardiography.
