Management Strategies and Clinical Outcomes of Methicillin Resistant Staphylococcus Aureus Native Vertebral Osteomyelitis: A Systematic Review and Meta-Analysis.

Abstract

Background context: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of native vertebral osteomyelitis (NVO) and is associated with persistent infection, complications, prolonged hospitalization, and increased mortality.

Purpose: We conducted this systematic review and meta-analysis to evaluate the antimicrobial and surgical approaches used for MRSA NVO and their associated clinical outcomes.

Study setting: Systematic review and meta-analysis.

Methods: A systematic literature search of MEDLINE, Scopus, and Web of Science was conducted on November 27, 2025. Studies were eligible if they included adults with MRSA NVO, evaluated medical or surgical treatment strategies, reported clinical outcomes, and included at least five patients. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using the Newcastle-Ottawa Scale and the Murad et al. tool. Random-effects models were used to pool proportions of treatment success, reinfection, and mortality.

Results: Thirty studies including 677 patients were included. Treatment strategies were heterogeneous and included prolonged anti-MRSA antimicrobial therapy and surgical approaches ranging from debridement and drainage to decompression and spinal stabilization or fusion. Vancomycin-based regimens were the most frequently reported antimicrobial strategy. Among studies reporting treatment duration, intravenous therapy commonly ranged from 4 to 8 weeks, with some patients receiving oral step-down or suppressive therapy. The pooled treatment success rate was 84.9% (95% CI, 76.7%-90.7%), pooled reinfection rate was 15.3% (95% CI, 9.5%-23.6%), and pooled mortality rate was 3.1% (95% CI, 0.8%-10.8%). Subgroup analyses were not feasible because treatment-specific data were limited and inconsistently reported.

Conclusions: Management of MRSA NVO varied substantially across studies, with vancomycin-based antimicrobial therapy and diverse surgical strategies commonly reported. Pooled outcomes showed high treatment success with lower rates of reinfection and mortality. The substantial clinical and methodological heterogeneity of the available evidence highlights the need for prospective studies with standardized treatment and outcome reporting.