Clinical characteristics of pyogenic vertebral osteomyelitis, and factors associated with inadequate treatment response.

OBJECTIVES: Pyogenic vertebral osteomyelitis (PVO) is associated with a high burden of disease. Our study aimed to describe characteristics at presentation of PVO, the risk of inadequate treatment response (ITR), relapse, and death, and to determine risk factors for ITR. METHODS: Patients with an ICD-10 discharge code for PVO and admission to a major Danish university hospital between November 2016 and April 2019 were included. ITR was defined as clinical, microbiological, and/or radiological progression during treatment. Data were collected through review of medical records, and logistic regression was used to determine adjusted odds ratios (aOR). RESULTS: Of 106 patients included, 87% presented with pain in the spine, 97% elevated CRP, 14% severe sepsis, and 13% with a history of previous spinal surgery. 39% were infected with Staphylococcus aureus and 9% with Escherichia coli. 31% responded inadequately to treatment, and risk factors for ITR were previous spinal surgery (aOR 19.29; 95% confidence interval (CI) 2.20-169.08), severe sepsis (aOR 4.59; 95% CI 1.28-15.41), and infection with Escherichia coli (aOR 8.10; 95% CI 1.71-38.45). 13% experienced relapse within the first 2 years, while the 1-year crude mortality was 12%. CONCLUSION: Staphylococcus aureus is still the main pathogen in PVO patients, and the risks of relapse and mortality remain high. Factors found to be associated with ITR were previous spinal surgery, severe sepsis, and infection with Escherichia coli.

The Hammer vs Mitigation-A comparative retrospective register study of the Swedish and Danish national responses to the COVID-19 pandemic in 2020.

In the efforts to dampen the COVID-19 pandemic, governments are compelled to outweigh disease control efforts to the possible negative consequences of closing large parts of society. Although Denmark and Sweden are alike in political organization and health care, national responses to the 2020 COVID-19 epidemic differed noticeably. Denmark initiated a hard lock down followed by an outbreak control strategy (the so-called "hammer and dance" strategy), while Sweden's strategy was based on advising on social distancing, while keeping society open (a so-called mitigative strategy). The objective of this study is to describe national epidemic control strategies in Denmark and Sweden in 2020, and compare the epidemic dynamics in the two countries, with respect to number of COVID-19 cases, admissions to intensive care and mortality. Data on epidemic control efforts and COVID-associated morbidity/mortality were downloaded from official government and epidemic surveillance webpages and comparatively described using basic statistics. Overall, we found "the hammer" resulted in better epidemic control during 2020 with less COVID-19-associated admissions to intensive care and lower mortality.