De novo methicillin-resistant Staphylococcus aureus vs. methicillin-sensitive Staphylococcus aureus infections of the sp
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ORIGINAL ARTICLE
De novo methicillin-resistant Staphylococcus aureus vs. methicillin-sensitive Staphylococcus aureus infections of the spine, similar clinical outcome, despite more severe presentation in surgical patients Basem Ishak 1,2 & Amir Abdul-Jabbar 1 & Gregory B. Moss 3 & Emre Yilmaz 1,4 & Alexander von Glinski 1,4 & Sven Frieler 1,4 & Andreas W. Unterberg 2 & Ronan Blecher 1 & Juan Altafulla 1 & Jeffrey Roh 1 & Robert A. Hart 1 & Rod J. Oskouian 1 & Jens R. Chapman 1 Received: 25 May 2020 / Revised: 18 July 2020 / Accepted: 20 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Vertebral osteomyelitis (VO) is a severe infection of the vertebral body and the adjacent disc space, where Staphylococcus aureus is most commonly isolated. The objective of this retrospective study was to determine risk factors for and compare outcome differences between de novo methicillin-resistant Staphylococcus aureus (MRSA) VO and methicillin-sensitive Staphylococcus aureus (MSSA) VO. A retrospective cohort study was performed by review of the electronic medical records of 4541 consecutive spine surgery patients. Among these 37 underwent surgical treatment of de novo MRSA and MSSA spinal infections. Patient demographics, pre- and postoperative neurological status (ASIA impairment score), surgical treatment, inflammatory laboratory values, nutritional status, comorbidities, antibiotics, hospital stay, ICU stay, reoperation, readmission, and complications were collected. A minimum follow-up (FU) of 12 months was required. Among the 37 patients with de novo VO, 19 were MRSA and 18 were MSSA. Mean age was 52.4 and 52.9 years in the MRSA and MSSA groups, respectively. Neurological deficits were found in 53% of patients with MRSA infection and in 17% of the patients with MSSA infection, which was statistically significant (p < 0.05). Chronic renal insufficiency and malnutrition were found to be significant risk factors for MRSA VO. Preoperative albumin was significantly lower in the MRSA group (p < 0.05). Patients suffering from spinal infection with chronic renal insufficiency and malnutrition should be watched more carefully for MRSA. The MRSA group did not show a significant difference with regard to final clinical outcome despite more severe presentation. Keywords Spinal infection . Vertebral osteomyelitis . MRSA . MSSA . Malnutrition . Albumin
Introduction
* Basem Ishak [email protected] 1
Swedish Neuroscience Institute, Seattle, WA, USA
2
Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
3
Department of Infectious Disease, Swedish Medical Center, Seattle, WA, USA
4
Department of Trauma Surgery, BG University Hospital Bochum, Bochum, Germany
De novo infections of the spine are an uncommon entity in spinal care, but when encountered, significant morbidity including prolonged hospitalization and neurologic compromise can be caused [29, 39]. Spondylitis, discitis, and epidural abscess can all be sequelae of hematogenous bacterial, yeast, or fungal infec
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