Temporal trends in incidence, clinical characteristics and outcomes of pyogenic vertebral osteomyelitis in Southern Denmark from 2009 to 2022: a retrospective population-based cohort study.

Authors

Susan Olaf Lindvig, Michala Kehrer, Inge Petersen, Søren Hess, Zahra Persson Theilgaard, Flemming Schønning Rosenvinge, Isik Somuncu Johansen

Published in

Annals of medicine. Volume 58. Issue 1. Pages 2738249. Epub Oct 21, 2026.

Abstract

Pyogenic vertebral osteomyelitis (PVO) is a severe infection with increasing incidence. We aimed to describe long-term population-based temporal trends in incidence, clinical presentation, diagnostic approaches, microbiology, and outcomes.
We conducted a retrospective population-based cohort study including 1,017 adults with multidisciplinary team-verified PVO diagnosed at a tertiary infectious diseases referral centre in the Region of Southern Denmark between 2009 and 2022. Incidence rates (IRs) per 100,000 person-years (PY) were calculated using regional population data and compared across three calendar periods (2009-2013, 2014-2018, 2019-2022). Temporal changes in clinical characteristics, microbiology, diagnostic strategies, and outcomes were assessed.
In total, 1,017 patients were included. The crude IR increased from 4.7 per 100,000 PY in 2009-2013 to 11.0 in 2019-2022, with the largest increase among patients aged ≥70 years. Mean age and comorbidity burden rose over time. Pain was common, fever was often absent, and neurological deficits occurred in 33.5% (n = 341). Postsurgical infection was the most frequent primary focus, and concomitant endocarditis occurred in 8.3% (n = 84). A microbiological diagnosis was established in 64.8% (n = 635) of cases, most commonly Staphylococcus aureus. Use of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography ([¹⁸F]FDG-PET/CT) increased over time. Median hospital stay remained 33 days. One-year mortality increased from 9.5% to 18.2%, while relapse declined, resulting in a stable composite risk of death or relapse (20.7%).
The incidence of PVO increased markedly from 2009 to 2022, predominantly in older patients with comorbidities. Despite improved diagnostics, microbiologically-negative cases remain frequent. Mortality remained high and increased over time.

PMID:
42902785
Bibliographic data and abstract were imported from PubMed on 22 Oct 2026.

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