A six-week antibiotic treatment of endocarditis with spondylodiscitis is not associated with increased risk of relapse: A retrospective cohort study - 05/12/20

Doi : 10.1016/j.medmal.2020.10.026

B. Castagné ^a,^⁎ , M. Soubrier ^b, J. Prouteau ^c, N. Mrozek ^c, O. Lesens ^c, A. Tournadre ^b, E. Gadea ^a, M. Vidal ^c
^a Service de médecine interne, centre hospitalier Émile-Roux, 12, boulevard Dr André-Chantemesse, 43000 Le Puy-en-Velay, France
^b Service de rhumatologie, CHU de Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
^c Service de maladies infectieuses, CHU de Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France

^⁎Auteur correspondant.

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Saturday 05 December 2020
This article has been published in an issue click here to access

Highlights

•	Spondylodiscitis and endocarditis are often associated.
•	A 6-week antibiotic treatment occasions little recurrence (<10%).
•	Associated endocarditis does not seem to increase the risk of recurrence.
•	Six-week antibiotherapy is well-tolerated.

El texto completo de este artículo está disponible en PDF.

Abstract

Background

We compared the relapse rate at 1 year in patients with vertebral osteomyelitis with or without associated endocarditis.

Patients and methods

We conducted a retrospective cohort study. Inclusion criteria were patients hospitalized in the infectious disease, rheumatology, cardiology, cardiovascular surgery and two internal medicine units for vertebral osteomyelitis (blood culture and/or disco-vertebral biopsy) and compatible imaging, between 2014 and 2017. We compared patients with associated endocarditis (VO-EI group) and without endocarditis (VO group) using logistic regression to determine the factors associated with relapse and EI. The main outcome was the relapse rate at 1 year.

Results

Out of the 207 eligible patients, 62 were included (35 in the VO group and 27 in the VO-EI group). Four patients presented with a new VO during follow-up, one (2.86%) patient in VO group and three (11.11%) in VO-EI group (P=0.68). There were more men in the VO-EI group than in the VO group (74.07% vs. 48.57%, P=0.04), valvulopathies (13/27 vs. 8/35, P=0.06), vertebral localization (1.22±0.50 vs. 1.03±0.17, P=0.04) and septic kidney embolism (5/27 vs. 0/35, P=0.01). Control blood cultures were more often positive in the VO-EI group (12/27 vs. 8/35, P=0.04). In 45% of patients, the germ was a staphylococcus, 29% streptococci, 10% enterococci, 10% gram-negative bacillus (GNB). There were more streptococci and enterococci in the VO-EI group than in the VO group (44.44% vs. 17.14% and 18.52% vs. 8.57%, respectively). Antibiotic safety was good and comparable between groups.