ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2026
Clinical Manifestations, Long-Term Trends, and Risk Factors for Treatment Failure in Native Vertebral Osteomyelitis: A 26-Year Mayo Clinic Experience.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed.
- Nomogram for predicting inadequate treatment response in vertebral osteomyelitis.Annals of medicine · 2026Article
- Hydrogel-integrated osteogenic microtissues promote repair of infected intervertebral defects through sequential immunomodulation.Materials today. Bio · 2026Article
- Integrating molecular and conventional diagnostics in native vertebral osteomyelitis: a narrative review.Journal of bone and joint infection · 2026Review
- From serum inflammatory markers to fluid, tissue, and molecular assays: current advances in the laboratory diagnosis of bone and joint infections.Frontiers in cellular and infection microbiology · 2026Review
- Article
- Integrating metagenomic next-generation sequencing into a multimodal diagnostic framework for spinal infection: enhancing etiological identification and clinical prediction.Frontiers in cellular and infection microbiology · 2026Article
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Abstract
backgroundNative vertebral osteomyelitis (NVO) is a life-threatening spinal infection with rising incidence and significant morbidity. Despite its growing burden, long-term data on clinical characteristics, management trends, and outcomes remain limited.
methodsWe conducted a 26-year multicenter retrospective cohort study of adults (≥18 years) diagnosed with NVO at Mayo Clinic sites between 1999 and 2024. Demographic, microbiologic, treatment, and outcome data were analyzed across five time periods. Predictors of treatment failure were assessed using a multivariable competing risk model.
resultsAmong 1255 patients (median age 67; 66% male), lumbosacral involvement was most common (65%), and 21% had multilevel involvement. Pathogens were identified in 77%, most commonly Staphylococcus aureus (49%; Methicillin-susceptible S. aureus 37%, methicillin-resistant S. aureus 13%). Over time from 1999-2004 to 2020-2024, Gram-negative bacilli increased from 6% to 14% (P = .048). Comorbidities including chronic kidney disease (10% to 21%), active chemotherapy (6% to 11%), and immunosuppression (8% to 17%) increased significantly. Additionally, 1-year treatment failure declined (16% to 10%). In multivariable analysis, diabetes mellitus (subdistribution hazard ratio [sHR] 1.92, 95% CI 1.18-3.13) and multilevel involvement (sHR 1.67, 95% CI 1.17-2.38) were associated with increased incidence of treatment failure, while concurrent infections (sHR 0.57, 95% CI 0.37-0.87) and higher Charlson Comorbidity Index (sHR 0.62, 95% CI 0.43-0.90) were associated with lower failure.
conclusionsThis large multicenter cohort highlights increasing host complexity, shifting microbiology, and predictors of failure, emphasizing the importance of early risk stratification and tailored strategies, such as multidisciplinary evaluation and close follow-up of high-risk patients to improve outcomes.
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