Treatment trends and outcomes of pyogenic vertebral osteomyelitis in Japan, 2015-2023: A descriptive epidemiological study.

Abstract

Background: Pyogenic vertebral osteomyelitis (PVO) is a rare but serious disease that presents diagnostic and therapeutic challenges. Although recent studies provide limited insights into its management trends, data on antibiotic regimens and surgical procedures remain scarce. This study aimed to assess real-world treatment trends for PVO in Japan.

Methods: We conducted a descriptive study using a hospital administrative database from 2015 to 2023. We included 1524 adult patients hospitalized for PVO in 50 hospitals that continuously contributed data during this period. We assessed antibiotic regimens (duration, trends in specific agents, and combination therapy), surgical procedures, and in-hospital mortality. We used the Cochran-Armitage trend test to evaluate annual changes, and examined factors associated with in-hospital mortality using univariable modified Poisson regression.

Results: The median duration of antibiotic therapy was 54 days. Although the proportion of patients receiving cefazolin (slightly over half) remained unchanged, there was a marked increase in the use of broad-spectrum antibiotics such as ceftriaxone, vancomycin, and piperacillin-tazobactam. During the oral phase, minocycline (33.5 %) and levofloxacin (24.8 %) were the most commonly prescribed. Approximately 30 % of patients received combination therapy, and this proportion did not change substantially over time. Surgical interventions increased during the study period, primarily because of rising posterior fixation procedures. In-hospital mortality was 5.2 %. Older age, heart failure, hemodialysis, and a higher Charlson Comorbidity Index were strongly associated with increased in-hospital mortality.

Conclusions: Our findings suggest that the treatment duration of PVO tended to be longer than guideline recommendations, whereas the selection of oral agents was consistent with them. The growing trend in posterior fixation surgeries may reflect the adoption of minimally invasive techniques such as percutaneous pedicle screw fixation. Older patients with heart and kidney failure require particular caution in treatment.