{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:26:25Z","timestamp":1790252785029,"version":"4.1.0"},"reference-count":36,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T00:00:00Z","timestamp":1637193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Empiric antibiotic therapy for suspected vertebral osteomyelitis (VO) should be initiated immediately in severely ill patients, and might be necessary for culture-negative VO. The current study aimed to identify differences between community-acquired (CA) and healthcare-associated (HA) VO in terms of clinical presentation, causative pathogens, and antibiotic susceptibility. Methods: Cases of adult patients with VO treated at a German university orthopaedic trauma center between 2000 and 2020 were retrospectively reviewed. Patient history was used to distinguish between CA and HA VO. Susceptibility of antibiotic regimens was assessed based on antibiograms of the isolated pathogens. Results: A total of 155 patients (with a male to female ratio of 1.3; and a mean age of 66.1 \u00b1 12.4 years) with VO were identified. In 74 (47.7%) patients, infections were deemed healthcare-associated. The most frequently identified pathogens were Staphylococcus aureus (HAVO: 51.2%; CAVO: 46.8%), and Coagulase-negative Staphylococci (CoNS, HAVO: 31.7%; CAVO: 21.3%). Antibiograms of 45 patients (HAVO: n = 22; CAVO: n = 23) were evaluated. Significantly more methicillin-resistant isolates, mainly CoNS, were found in the HAVO cohort (27.3%). The highest rate of resistance was found for cefazolin (HAVO: 45.5%; CAVO: 26.1%). Significantly higher rates of resistances were seen in the HAVO cohort for mono-therapies with meropenem (36.4%), piperacillin\u2013tazobactam (31.8%), ceftriaxone (27.3%), and co-amoxiclav (31.8%). The broadest antimicrobial coverage was achieved with either a combination of piperacillin\u2013tazobactam + vancomycin (CAVO: 100.0%; HAVO: 90.9%) or meropenem + vancomycin (CAVO: 100.0%; HAVO: 95.5%). Conclusion: Healthcare association is common in VO. The susceptibility pattern of underlying pathogens differs from CAVO. When choosing an empiric antibiotic, combination therapy must be considered.<\/jats:p>","DOI":"10.3390\/antibiotics10111410","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T08:53:56Z","timestamp":1637225636000},"page":"1410","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Is There a Difference in Clinical Features, Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Healthcare-Associated and Community-Acquired Vertebral Osteomyelitis?"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0459-9092","authenticated-orcid":false,"given":"Siegmund","family":"Lang","sequence":"first","affiliation":[{"name":"Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Fr\u00f6mming","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nike","family":"Walter","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viola","family":"Freigang","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Neumann","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Loibl","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"},{"name":"Department of Spine Surgery, Schulthess Clinic, Lenghalde 2, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Ehrenschwender","sequence":"additional","affiliation":[{"name":"Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0208-4650","authenticated-orcid":false,"given":"Volker","family":"Alt","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Rupp","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1017\/S0950268807008850","article-title":"Epidemiology of vertebral osteomyelitis (VO) in France: Analysis of hospital-discharge data 2002\u20132003","volume":"136","author":"Grammatico","year":"2008","journal-title":"Epidemiol. Infect."},{"key":"ref_2","first-page":"2","article-title":"Epidemiological and clinical features of pyogenic spondylodiscitis","volume":"16","author":"Fantoni","year":"2012","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/S0163-4453(97)92395-1","article-title":"Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980\u20131990","volume":"34","author":"Jensen","year":"1997","journal-title":"J. Infect."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1093\/bmb\/ldw003","article-title":"Vertebral osteomyelitis in adults: An update","volume":"117","author":"Nickerson","year":"2016","journal-title":"Br. Med. Bull."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.jinf.2013.11.011","article-title":"Increasing incidence of pyogenic spondylodiscitis: A 14-year population-based study","volume":"68","author":"Kehrer","year":"2014","journal-title":"J. Infect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1007\/s00113-021-01002-w","article-title":"Infections of the spine: Pyogenic spondylodiscitis and implant-associated vertebral osteomyelitis","volume":"124","author":"Lang","year":"2021","journal-title":"Unfallchirurg"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1093\/qjmed\/94.9.465","article-title":"A case ascertainment study of septic discitis: Clinical, microbiological and radiological features","volume":"94","author":"Hopkinson","year":"2001","journal-title":"QJM"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2787","DOI":"10.1007\/s00586-013-2850-1","article-title":"Spinal infection: State of the art and management algorithm","volume":"22","author":"Duarte","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e365","DOI":"10.1097\/MD.0000000000000365","article-title":"Health care associated hematogenous pyogenic vertebral osteomyelitis: A severe and potentially preventable infectious disease","volume":"94","author":"Pigrau","year":"2015","journal-title":"Medicine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1086\/340102","article-title":"Vertebral osteomyelitis: Long-term outcome for 253 patients from 7 Cleveland-area hospitals","volume":"34","author":"McHenry","year":"2002","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.semarthrit.2008.03.002","article-title":"Pyogenic vertebral osteomyelitis: A systematic review of clinical characteristics","volume":"39","author":"Mylona","year":"2009","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.diagmicrobio.2017.01.020","article-title":"Hematogenous vertebral osteomyelitis associated with intravascular device-associated infections\u2014A retrospective cohort study","volume":"88","author":"Renz","year":"2017","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1093\/cid\/civ482","article-title":"2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults","volume":"61","author":"Berbari","year":"2015","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1007\/s00586-017-5043-5","article-title":"New classification for the treatment of pyogenic spondylodiscitis: Validation study on a population of 250 patients with a follow-up of 2 years","volume":"26","author":"Pola","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1007\/s15010-018-1177-6","article-title":"Native vertebral osteomyelitis in aged patients: Distinctive features. An observational cohort study","volume":"46","author":"Pigrau","year":"2018","journal-title":"Infection"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1007\/s00586-020-06519-z","article-title":"Quality of life and mortality after surgical treatment for vertebral osteomyelitis (VO): A prospective study","volume":"30","author":"Yagdiran","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Yu, D., Kim, S.W., and Jeon, I. (2020). Antimicrobial therapy and assessing therapeutic response in culture-negative pyogenic vertebral osteomyelitis: A retrospective comparative study with culture-positive pyogenic vertebral osteomyelitis. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05669-1"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s10096-020-04022-3","article-title":"Microbiological diagnosis of suspected vertebral osteomyelitis with a focus on the yield of percutaneous needle biopsy: A 10-year cohort study","volume":"40","author":"Avenel","year":"2021","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"iii11","DOI":"10.1093\/jac\/dkq303","article-title":"Spondylodiscitis: Update on diagnosis and management","volume":"65","author":"Gouliouris","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2065","DOI":"10.1007\/s10096-020-03929-1","article-title":"How is the microbial diagnosis of bacterial vertebral osteomyelitis performed? An 11-year retrospective study","volume":"39","author":"Amsilli","year":"2020","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Park, K.-H., Kim, D.Y., Lee, Y.-M., Lee, M.S., Kang, K.-C., Lee, J.-H., Park, S.Y., Moon, C., Chong, Y.P., and Kim, S.-H. (2019). Selection of an appropriate empiric antibiotic regimen in hematogenous vertebral osteomyelitis. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0211888"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Michels, R., Last, K., Becker, S.L., and Papan, C. (2021). Update on Coagulase-Negative Staphylococci-What the Clinician Should Know. Microorganisms, 9.","DOI":"10.3390\/microorganisms9040830"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Lopez, J., Tatar, Z., Tournadre, A., Couderc, M., Pereira, B., Soubrier, M., and Dubost, J.-J. (2017). Characteristics of spontaneous coagulase-negative staphylococcal spondylodiscitis: A retrospective comparative study versus Staphylococcus aureus spondylodiscitis. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2783-0"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s100960050441","article-title":"Spondylodiscitis associated with bacteraemia due to coagulase-negative staphylococci","volume":"19","author":"Bucher","year":"2000","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1007\/s15010-007-7065-0","article-title":"Serum procalcitonin for discrimination of blood contamination from bloodstream infection due to coagulase-negative staphylococci","volume":"35","author":"Schuetz","year":"2007","journal-title":"Infection"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"284","DOI":"10.3947\/ic.2019.51.3.284","article-title":"Antibiotic Treatment of Vertebral Osteomyelitis caused by Methicillin-Susceptible Staphylococcus aureus: A Focus on the Use of Oral \u03b2-lactams","volume":"51","author":"Oh","year":"2019","journal-title":"Infect. Chemother."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1007\/s00132-012-1920-0","article-title":"Systemic and local antibiotic therapy of conservative and operative treatment of spondylodiscitis","volume":"41","author":"Fleege","year":"2012","journal-title":"Der Orthop."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.jinf.2014.02.009","article-title":"Clinical characteristics and outcomes of hematogenous vertebral osteomyelitis caused by gram-negative bacteria","volume":"69","author":"Park","year":"2014","journal-title":"J. Infect."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4264","DOI":"10.1128\/AAC.00431-09","article-title":"Antibiotic Usage and Risk of Colonization and Infection with Antibiotic-Resistant Bacteria: A Hospital Population-Based Study","volume":"53","author":"Tacconelli","year":"2009","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1097\/IPC.0000000000000116","article-title":"Comparative Analysis of Daptomycin and Vancomycin in the Treatment of Vertebral Osteomyelitis","volume":"22","author":"Rangaraj","year":"2014","journal-title":"Infect. Dis. Clin. Pract."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1007\/s00132-020-03942-4","article-title":"Development and current use of local antibiotic carriers in spondylodiscitis","volume":"49","author":"Fleege","year":"2020","journal-title":"Orthop\u00e4de"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1148\/radiol.2282020752","article-title":"MR Imaging Findings in Spinal Infections: Rules or Myths?","volume":"228","author":"Ledermann","year":"2003","journal-title":"Radiology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"E43","DOI":"10.1007\/s00330-003-2046-x","article-title":"Vertebral infection","volume":"14","author":"Jevtic","year":"2004","journal-title":"Eur. Radiol. Suppl."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1093\/cid\/ciw098","article-title":"Optimal Duration of Antibiotic Therapy in Patients with Hematogenous Vertebral Osteomyelitis at Low Risk and High Risk of Recurrence","volume":"62","author":"Park","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic. Dis."},{"key":"ref_36","unstructured":"(2021, November 08). EUCAST: AST of Bacteria n.d. Available online: https:\/\/www.eucast.org\/ast_of_bacteria\/."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/11\/1410\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:31:56Z","timestamp":1760167916000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/11\/1410"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,18]]},"references-count":36,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["antibiotics10111410"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics10111410","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,18]]}}}