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Multicenter Audit of Native Vertebral Osteomyelitis: UK Guidelines and Patient Characteristics

This retrospective audit aims to evaluate the management of patients with native vertebral osteomyelitis (NVO) in UK centers, compare it against IDSA guidelines, and identify common factors and predictors of poor outcomes. The study includes approximately 80 NVO cases from 10 study sites over a 10-month period.

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Multicenter Audit of Native Vertebral Osteomyelitis: UK Guidelines and Patient Characteristics

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  1. A Multicenter Retrospective Audit of Native Vertebral Osteomyelitis Cases June 2017- March 2018

  2. Introduction • Native VO is a rare but important diagnosis to consider in patients presenting with back pain  easily missed and misdiagnosed. • Incidence is increasing - largely due to a growing ageing population with a rising incidence of chronic conditions and immunocompromised. • It is typically monomicrobial with Staph. aureus most commonly implicated. • In infection, inflammatory destruction can rapidly lead to bone necrosis & severe, life-threatening morbidity • Currently, effective and appropriate management of suspected NVO is hindered by the lack of standardised UK guidelines Innovation and excellence in health and care

  3. Objectives • To audit the service provided to patients receiving treatment for NVO in centers throughout the UK against IDSA guidelines (2015). • To describe specific characteristics of this patient group in order to target future services effectively, specifically: • Which common factors do the majority of patients with NVO share? • Which factors (demographics, microbiology, serum inflammatory markers, and imaging studies) are useful in predicting poorer outcomes for patients with NVO? Innovation and excellence in health and care

  4. Sample size • Approx 11 cases of NVO were diagnosed at Cambridge University Hospital (Oct 2014-Dec 2015), 0.73 cases per month • We aim to include approx.10 study sites and with each centre contributing 8 patients, this would include an audit of 80 patients in total. Innovation and excellence in health and care

  5. Inclusion and exclusion criteria • Inclusion criteria: • All patients with a 1st diagnosis of NVO presenting to hospital in the 2yr period (Jan 15-Dec 16 inclusive), including NVO from pyogenic bacteria, fungal and mycobacterial causes. • Exclusion criteria: • Paediatric patients, aged 15 years or younger • Implant-associated vertebral osteomyelitis • Recurrent native vertebral osteomyelitis Innovation and excellence in health and care

  6. Design and Methods • Period of evaluation – June ’17- March ’18 (approx. 10 months including local data collection, central data collation and analysis) • Data collection • Individuals in each centre will use a paper proforma • Proformas should be collected and kept locked securely on site by each centre’s coordinator for reference • Each centre’s data (anonymised and patient identifiable data removed) will be compiled and entered into a standardised Excel spreadsheet. • Spreadsheets from individual centres should be securely shared using the nhs.net email system and centrally collated by the lead centre , ready for data analysis. Innovation and excellence in health and care

  7. Design and Methods • Searching - the various searches chosen by individual centres to identify audit subjects may include: • Patients with the ICD-10 discharge diagnosis codes: • Osteomyelitis of vertebra: M46.2 • Discitis, unspecified: M46.4 • Osteomyelitis, unspecified: M86.9 etc • Patients with ICD-10 codes relating to the procedure performed: • Vertebral biopsy: V47 • Biopsy of spinal tract, open: A45.4 • Patients on the OPAT database with NVO. • Patients on the radiology database found using searches such as “osteomyelitis of vertebra”. • Patients on the Infectious diseases or microbiology team database with NVO. Innovation and excellence in health and care

  8. Standards • The Infectious Disease Society of America (IDSA) has published guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults • We have selected 8 recommendations and suggestions from this guideline as standards for this audit: Innovation and excellence in health and care

  9. Proforma – Patient Characteristics Innovation and excellence in health and care

  10. Proforma – Patient Characteristics Innovation and excellence in health and care

  11. Proforma – Severity of Comorbidities Innovation and excellence in health and care

  12. Proforma – Severity of Comorbidities Innovation and excellence in health and care

  13. Proforma – Severity of Comorbidities Innovation and excellence in health and care

  14. Proforma – Severity of Comorbidities Innovation and excellence in health and care

  15. Proforma – Severity of Comorbidities Innovation and excellence in health and care

  16. Proforma – Standard 1 Innovation and excellence in health and care

  17. Proforma – Standard 2 Innovation and excellence in health and care

  18. Proforma – Standard 3 Innovation and excellence in health and care

  19. Proforma – Standard 3 Innovation and excellence in health and care

  20. Proforma – Standard 4 Innovation and excellence in health and care

  21. Proforma – Standard 5 Innovation and excellence in health and care

  22. Proforma – Standard 5 Innovation and excellence in health and care

  23. Proforma – Standard 6 Innovation and excellence in health and care

  24. Proforma – Standard 7 Innovation and excellence in health and care

  25. Proforma – Standard 7 Innovation and excellence in health and care

  26. Proforma – Standard 8 Innovation and excellence in health and care

  27. Proforma – Hospital Data Innovation and excellence in health and care

  28. Proforma – Hospital Data Innovation and excellence in health and care

  29. Proforma – Hospital Data Innovation and excellence in health and care

  30. Expected time frame • Interested hospitals need to confirm participation by 31st August ’17 • Data collection – any time between June to October ’17 • Deadline for data submission – 30th November ’17 Innovation and excellence in health and care

  31. Dissemination and publication of data • Pooled results from the audit will be fed back to all participating hospitals. • Results will then be submitted for presentation at national and international conferences and for publication • Individual hospital details will remain anonymised when results are presented and they will not be identifiable. Innovation and excellence in health and care

  32. Any questions? Innovation and excellence in health and care

  33. Acknowledgements • Dr R Bousfield, Infectious Diseases/ Microbiology SpR, Cambridge University Hospitals NHS Trust • Dr E Nickerson, Infectious Diseases SpR, Cambridge University Hospitals NHS trust • Dr I Ramsay, Combined Infection Trainee, Cambridge University Hospitals NHS Trust • Dr B Warne, Combined Infection Trainee, Cambridge University Hospitals NHS Trust • Dr E Moore, Consultant Infectious Diseases Physician • Deevia Kotecha, Medical Student, University of Leicester Innovation and excellence in health and care

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