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

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

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

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

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

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

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

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

Proforma – Patient Characteristics Innovation and excellence in health and care

Proforma – Patient Characteristics Innovation and excellence in health and care

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

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

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

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

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

Proforma – Standard 1 Innovation and excellence in health and care

Proforma – Standard 2 Innovation and excellence in health and care

Proforma – Standard 3 Innovation and excellence in health and care

Proforma – Standard 3 Innovation and excellence in health and care

Proforma – Standard 4 Innovation and excellence in health and care

Proforma – Standard 5 Innovation and excellence in health and care

Proforma – Standard 5 Innovation and excellence in health and care

Proforma – Standard 6 Innovation and excellence in health and care

Proforma – Standard 7 Innovation and excellence in health and care

Proforma – Standard 7 Innovation and excellence in health and care

Proforma – Standard 8 Innovation and excellence in health and care

Proforma – Hospital Data Innovation and excellence in health and care

Proforma – Hospital Data Innovation and excellence in health and care

Proforma – Hospital Data Innovation and excellence in health and care

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

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

Any questions? Innovation and excellence in health and care

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