Selection of an appropriate empiric antibiotic regimen in hematogenous vertebral osteomyelitis

• DOI: 10.1371/journal.pone.0211888
• Publication Date: 2019-02-08T18:32:46Z
• Authors: Ki-Ho Park; Dong Youn Kim; Yu-Mi Lee; Mi Suk Lee; Kyung-Chung Kang; Jung-Hee Lee; Seong Yeon Park; Chisook Moon; Yong Pil Chong; Sung-Han Kim; Sang-Oh Lee; Sang-Ho Choi; Yang Soo Kim; Jun Hee Woo; Byung-Han Ryu; In-Gyu Bae; Oh-Hyun Cho
• Keywords: Cefepime; Empiric therapy

Background Empiric antibiotic therapy for suspected hematogenous vertebral osteomyelitis (HVO) should be initiated immediately in seriously ill patients and may required those with negative microbiological results. The aim of this study was to inform the appropriate selection empiric regimens treatment HVO by analyzing antimicrobial susceptibility isolated bacteria from microbiologically proven HVO. Method We conducted a retrospective chart review adult five tertiary-care hospitals over 7-year period. appropriateness assessed based on profiles bacteria. Results In total, 358 cases were identified. main causative pathogens identified methicillin-susceptible Staphylococcus aureus (33.5%), followed methicillin-resistant S. (MRSA) (24.9%), Enterobacteriaceae (19.3%), Streptococcus species (11.7%). Extended spectrum β-lactamase (ESBL)-producing anaerobes accounted only 1.7% 1.4%, respectively, pathogens. Overall, 73.5% susceptible levofloxacin plus rifampicin, 71.2% clindamycin, 64.5% amoxicillin-clavulanate ciprofloxacin. these oral combinations lower healthcare-associated (52.6%, 49.6%, 37.6%, respectively) than community-acquired (85.8%, 84.0%, 80.4%, respectively). Vancomycin combined ciprofloxacin, ceftriaxone, ceftazidime, or cefepime similarly (susceptibility rates 93.0%, 94.1%, 95.8%, Conclusions Based our data, vancomycin broad-spectrum cephalosporin fluoroquinolone Fluoroquinolone-based not due frequent resistance agents, especially