{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T21:53:01Z","timestamp":1793829181406,"version":"4.6.1"},"reference-count":31,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,8,6]],"date-time":"2021-08-06T00:00:00Z","timestamp":1628208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF-2019M3E5D1A02068142"],"award-info":[{"award-number":["NRF-2019M3E5D1A02068142"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Backgroundand objectives: The clinical assessment of therapeutic response in pyogenic vertebral osteomyelitis (PVO) has been usually performed based on the changes of clinical symptoms and blood inflammatory markers. Recently, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has emerged as an alternative independent method. We analyzed the validity of the clinical assessment for detecting residual PVO based on 18F-FDG-PET. Materials and Methods: This study was conducted with 53 patients confirmed as lumbar PVO under retrospective design. All patients underwent clinical assessment using clinical symptoms and C-reactive protein (CRP) for therapeutic response after parenteral antibiotic therapy, which led to the decision of placement in the uncontrolled (group UC) or controlled (group C) group. The validity of clinical assessment was analyzed based on the cut-off values of FDG uptake for detecting residual PVO as references, which are already established in the previous literature. Results: The mean duration of parenteral antibiotic therapy and recurrence rate were 42.19 \u00b1 15.84 (21\u201389) days and 9.4% (5\/53), respectively. 18F-FDG-PETs were performed at 80 rounds of clinical assessment on 37.40 \u00b1 13.15 (21\u201383) days of parenteral antibiotic therapy and divided: 31 into group UC and 49 into group C, according to the decisions of clinical assessment. Based on the cut-off values of FDG uptake, clinical assessment showed 48.4\u201358.1% of false positive for residual PVO in group UC. However, 18F-FDG-PET showed 8.2% (4\/49) of false negative for residual PVO in group C, which led to recurrences. Conclusions: Clinical assessment using clinical symptoms and CRP for evaluating therapeutic response in PVO is still a useful method in terms of similar recurrence rate compared to 18F-FDG-PET. However, the high rate of false positive for residual PVO can prolong the use of unnecessary antibiotics and overall treatment period.<\/jats:p>","DOI":"10.3390\/medicina57080809","type":"journal-article","created":{"date-parts":[[2021,8,8]],"date-time":"2021-08-08T21:49:41Z","timestamp":1628459381000},"page":"809","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Validity of Clinical Assessment Using Clinical Symptoms and C-Reactive Protein for Therapeutic Response in Pyogenic Vertebral Osteomyelitis: Analysis Based on 18F-FDG-PET"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1293-2724","authenticated-orcid":false,"given":"Ikchan","family":"Jeon","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Yeungnam University College of Medicine, Daegu 42415, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongwoo","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yeungnam University College of Medicine, Daegu 42415, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunjung","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Yeungnam University College of Medicine, Daegu 42415, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1136\/ard.56.12.709","article-title":"Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: A descriptive and comparative study of 219 cases","volume":"56","author":"Colmenero","year":"1997","journal-title":"Ann. Rheum. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E102","DOI":"10.1097\/BSD.0000000000000597","article-title":"The Epidemiology of Vertebral Osteomyelitis in the United States from 1998 to 2013","volume":"31","author":"Issa","year":"2018","journal-title":"Clin. Spine Surg."},{"key":"ref_3","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."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1093\/clinids\/19.4.746","article-title":"Pyogenic and Tuberculous Spondylodiskitis (Vertebral Osteomyelitis) in 80 Adult Patients","volume":"19","author":"Perronne","year":"1994","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s10096-018-3197-7","article-title":"Diagnostic challenges in pyogenic spinal infection: An expanded role for FDG-PET\/CT","volume":"37","author":"Yu","year":"2018","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1056\/NEJMcp0910753","article-title":"Clinical practice. Vertebral Osteomyelitis","volume":"362","author":"Zimmerli","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.semarthrit.2014.04.008","article-title":"Outcome of culture-negative pyogenic vertebral osteomyelitis: Comparison with microbiologically confirmed pyogenic vertebral osteomyelitis","volume":"44","author":"Kim","year":"2014","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1093\/rheumatology\/kel228","article-title":"Imaging does not predict the clinical outcome of bacterial vertebral osteomyelitis","volume":"46","author":"Zarrouk","year":"2007","journal-title":"Rheumatology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1097\/00007632-199709150-00005","article-title":"The Clinical Use of Erythrocyte Sedimentation Rate in Pyogenic Vertebral Osteomyelitis","volume":"22","author":"Carragee","year":"1997","journal-title":"Spine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"626","DOI":"10.3947\/ic.2020.52.4.626","article-title":"Application of Simultaneous 18F-FDG PET\/MRI for Evaluating Residual Lesion in Pyogenic Spine Infection: A Case Report","volume":"52","author":"Jeon","year":"2020","journal-title":"Infect. Chemother."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Jeon, I., Kong, E., and Kim, S.W. (2019). Simultaneous 18F-FDG PET\/MRI in tuberculous spondylitis: An independent method for assessing therapeutic response\u2014Case series. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-4469-2"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1007\/s00259-012-2179-8","article-title":"FDG PET\/CT is useful for the interim evaluation of response to therapy in patients affected by haematogenous spondylodiscitis","volume":"39","author":"Nanni","year":"2012","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2424","DOI":"10.1097\/BRS.0b013e3181b1fd33","article-title":"Prediction of Residual Disease of Spine Infection Using F-18 FDG PET\/CT","volume":"34","author":"Kim","year":"2009","journal-title":"Spine"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Jeon, I., Kong, E., Kim, S.W., Cho, I.H., and Hong, C.P. (2020). Assessment of Therapeutic Response in Pyogenic Vertebral Osteomyelitis Using (18)F-FDG-PET\/MRI. Diagnostics, 10.","DOI":"10.3390\/diagnostics10110916"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Jeon, I., Kong, E., Yu, D., and Hong, C.P. (2020). Clinical and Radiological Analysis of Pyogenic Vertebral Osteomyelitis Immediately after Successful Antimicrobial Therapy: Considerations for Assessing Therapeutic Response. Diagnostics, 10.","DOI":"10.3390\/diagnostics10110861"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1086\/505118","article-title":"Do Follow-Up Imaging Examinations Provide Useful Prognostic Information in Patients with Spine Infection?","volume":"43","author":"Kowalski","year":"2006","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.spinee.2005.07.006","article-title":"Serum C-reactive protein levels correlate with clinical response in patients treated with antibiotics for wound infections after spinal surgery","volume":"6","author":"Khan","year":"2006","journal-title":"Spine J. Off. J. N. Am. Spine Soc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"317","DOI":"10.3340\/jkns.2007.42.4.317","article-title":"A Clinical Analysis of Surgical Treatment for Spontaneous Spinal Infection","volume":"42","author":"Lee","year":"2007","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/BF00301305","article-title":"New inflammation markers for early detection of spondylodiscitis","volume":"1","author":"Zilkens","year":"1992","journal-title":"Eur. Spine J."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Babouee Flury, B., Elzi, L., Kolbe, M., Frei, R., Weisser, M., Sch\u00e4ren, S., Widmer, A.F., and Battegay, M. (2014). Is switching to an oral antibiotic regimen safe after 2 weeks of intravenous treatment for primary bacterial vertebral osteomyelitis?. BMC Infect. Dis., 14.","DOI":"10.1186\/1471-2334-14-226"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s00586-009-1216-1","article-title":"Pyogenic vertebral osteomyelitis: Identification of microorganism and laboratory markers used to predict clinical outcome","volume":"19","author":"Yoon","year":"2010","journal-title":"Eur. Spine J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/S0140-6736(14)61233-2","article-title":"Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: An open-label, non-inferiority, randomised, controlled trial","volume":"385","author":"Bernard","year":"2015","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1053\/j.semnuclmed.2008.08.002","article-title":"Clinically Proven Radiopharmaceuticals for Infection Imaging: Mechanisms and Applications","volume":"39","author":"Goldsmith","year":"2009","journal-title":"Semin. Nucl. Med."},{"key":"ref_24","first-page":"376","article-title":"Histopathological aspects of chronic recurrent multifocal osteomyelitis","volume":"62","author":"Boquist","year":"1980","journal-title":"J. Bone Jt. Surgery Br. Vol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1007\/s12149-011-0521-z","article-title":"The molecular imaging approach to image infections and inflammation by nuclear medicine techniques","volume":"25","author":"Signore","year":"2011","journal-title":"Ann. Nucl. Med."},{"key":"ref_26","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."},{"key":"ref_27","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. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_28","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_29","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/s00264-011-1425-1","article-title":"Treatment of spondylodiscitis","volume":"36","author":"Zarghooni","year":"2012","journal-title":"Int. Orthop."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.semarthrit.2006.09.004","article-title":"Optimal Duration of Antibiotic Therapy in Vertebral Osteomyelitis","volume":"36","author":"Roblot","year":"2007","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jbspin.2006.11.002","article-title":"Suggestions for managing pyogenic (non-tuberculous) discitis in adults","volume":"74","author":"Grados","year":"2007","journal-title":"Jt. Bone Spine"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/8\/809\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:41:53Z","timestamp":1760164913000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/8\/809"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,6]]},"references-count":31,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["medicina57080809"],"URL":"https:\/\/doi.org\/10.3390\/medicina57080809","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,6]]}}}