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Observational Study
. 2025 Apr;44(4):819-825.
doi: 10.1007/s10096-025-05041-8. Epub 2025 Jan 21.

Vertebral osteomyelitis in patients with infective endocarditis: prevalence, risk factors and mortality

S Douiyeb  1   2 , K C E Sigaloff  3   4 , E G Ulas  5 , M G J Duffels  5 , O Drexhage  5 , T Germans  5 , J F P Wagenaar  6 , D T P Buis  3   4 , T W van der Vaart  7   8 , C H van Werkhoven  8 , J M Prins  7 , V A W M Umans  5
Affiliations
Observational Study

Vertebral osteomyelitis in patients with infective endocarditis: prevalence, risk factors and mortality

S Douiyeb et al. Eur J Clin Microbiol Infect Dis. 2025 Apr.

Abstract

Purpose: Infective endocarditis (IE) can be complicated by vertebral osteomyelitis (VO). This study investigates risk factors associated with VO in patients with infective endocarditis, and 6-month mortality and relapse rates in patients with IE and concomitant VO.

Methods: We performed a observational study in two hospitals between September 2016 and October 2022. Patients with possible or definite IE according European Society of Cardiology (2015) modified criteria were retrieved from the local endocarditis team registries. The VO diagnosis was based on radiological signs, irrespective of clinical symptoms. Multivariable logistic regression analysis was performed to identify risk factors for vertebral osteomyelitis.

Results: We included 633 consecutive patients with IE. A total of 229 (36.2%) patients had prosthetic valves and 127 (20.1%) had cardiac implantable electronic devices. The most frequent causative micro-organism was Streptococcus species (217, 34.3%), followed by Staphylococcus aureus (167, 26.4%). VO was diagnosed in 73 patients (11.5%, 95% CI 9.0%-14.0%). Enterococcus spp.(OR 2.48, 95% CI 1.31-4.52) and age (OR 1.04 per year, 95% CI 1.02-1.06) were independently associated with concomitant VO. The 6-month mortality risk did not differ between patients with (16/73, 21.9%) or without (110/560, 19.6%) VO (HR 1.13, 95% CI 0.67-1.91). Relapse rate was higher in patients with VO but the difference was not statistically significant (16.1 vs. 7.5%, OR 3.62, 95% CI 0.94-13.34).

Conclusions: Twelve percent of patients with IE also had VO. Among older patients and patients with IE caused by enterococci, there should be a higher index of suspicion for vertebral infection.

Keywords: Age; Enterococci; Infectious endocarditis; Spondylodiscitis; Vertebral osteomyelitis.

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Conflict of interest statement

Declarations. Ethical approval: This study is an observational study. The study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University of Amsterdam UMC (Date 12-10-2023./No METC2023.0424). In the Noordwest Hospital the Research Ethics Committee has confirmed that no ethical approval is required. Competing interests: Dr. van Werkhoven has received grants from DaVolterra, bioMerieux and LimmaTech which were paid to the institution. Dr. van Werkhoven has received consulting fees from Merck/MSD and Sanofi-Pasteur in regards to pneumococcal vaccines. These payments were made to the institution.

Figures

Fig. 1
Fig. 1
6 month mortality in patients with infective endocarditis with and without VO
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References

    1. de Sèze S, Ryckewaert A, Kahn MF, Simonin JL, Heuleu JN (Dec 1965) [Osler’s endocarditis in rheumatology]. (in Fre), Rev Rhum Mal Osteoartic, L’endocardite d’Osler en rhumatologie 32(12):739–744. - PubMed
    1. Carbone A et al (Dec 2020) Spondylodiscitis complicating infective endocarditis, Heart 106(24):1914–1918. 10.1136/heartjnl-2019-316492 - PubMed
    1. Pace SD et al (Apr 15 2021) Endocarditis with spondylodiscitis: clinical characteristics and prognosis. BMC Cardiovasc Disord 21(1):186. 10.1186/s12872-021-01991-x - PMC - PubMed
    1. Tamura K (2010) Clinical characteristics of infective endocarditis with vertebral osteomyelitis. J Infect Chemother 16(4):260–265. 01/01/2010 10.1007/s10156-010-0046-8 - PubMed
    1. Le Moal G et al (Sep 2002) Clinical and laboratory characteristics of infective endocarditis when associated with spondylodiscitis. Eur J Clin Microbiol Infect Dis 21(9):671–675. 10.1007/s10096-002-0798-x - PubMed

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