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Summary:

The study aimed to evaluate the epidemiology, risk factors, and outcomes of native vertebral osteomyelitis (NVO) in patients with Staphylococcus aureus bacteremia (SAB). By conducting a retrospective analysis at the Mayo Clinic, data were collected from patients aged 18 years or older who developed NVO between January 1, 2006, and December 31, 2020. Key findings were drawn from a 1:2 nested case-control analysis that compared patients who developed NVO to controls matched for age, sex, and year of SAB diagnosis.

Key Results:

• Patient Demographics:

  • 103 patients had NVO.
  • The majority (60.2%) of the patients were male, with a median age of 62 years.
  • 30.1% of NVO cases were caused by methicillin-resistant S. aureus (MRSA).

• Commonly Affected Areas:

  • The lumbar spine was the most commonly affected region (57.6% of cases).

• Comorbidities:

  • Diabetes mellitus (36.9%) and coronary artery disease (27.2%) were frequently observed.

• Mortality:

  • Mortality at three months post-SAB was 18.6%.

Risk Factors:

• Significant risk factors for developing NVO included injection drug use (IDU) and tobacco consumption.
• Conversely, patients with chronic hemodialysis and chronic liver disease (CLD) were less likely to develop NVO.

Conclusions:

The study highlights that atherosclerotic vascular disease was prevalent in patients with NVO in the context of SAB. The role of diabetes, tobacco use, older age, and male sex likely influenced this profile. Given the association between IDU and NVO, the ongoing opioid crisis in the United States may result in a rising number of NVO cases. This underscores the need for increased vigilance in populations at risk, particularly those with a history of IDU.

level of evidence: moderate (nested case control analysis, retrospective design is a limiting factor)