Bugs and bones: a study of 25 cases of infectious spondylodiscitis (original) (raw)
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A Seven-Year Prospective Study on Spondylodiscitis: Epidemiological and Microbiological Features
Infection, 2010
Background: The aim of this paper was to enlarge the available knowledge on clinical and etiological aspects of patients affected by spondylodiscitis. Patients and Methods: All patients with spondylodiscitis admitted between January 2001 and December 2007 at the 1,300-bed University Hospital ''Policlinico Umberto I'' of Rome, Italy, were followed. Demographic characteristics, underlying diseases, invasive procedures, imaging studies, isolated microorganisms, treatment, complications, and outcome were recorded. Results: Eighty-one patients of mean age 57.7 ± 14.7 years with lumbosacral (72.8%), thoracic (14.8%), and cervical tract (12.3%) site of infection were included, of which 38 developed communityacquired (CA) spondylodiscitis and 43 developed hospital-acquired (HA) spondylodiscitis. Underlying disease was present in 49.4% of patients. HA spondylodiscitis was diagnosed earlier (46.8 ± 49.7 days) than CA spondylodiscitis (65.0 ± 55.4 days) (P < 0.05). The most frequently isolated microorganisms were Staphylococcus aureus (28 strains, 43.1%), coagulase-negative staphylococci (CNS) (eight strains, 12.3%), Pseudomonas aeruginosa (eight strains, 12.3%), and three methicillin-resistant S. aureus (MRSA) strains were isolated in CA spondylodiscitis. Fungi and yeasts, isolated in six patients, represented 9.2% of all strains but 17.6% when considering only HA spondylodiscitis. Over 85% of patients were managed by conservative treatment alone, and the treatment time depended on clinical and laboratory evidence. Poor outcome was recorded in 12 (14.8%) patients, and was associated with neurological deficit symptoms (relative risk [RR] 2.87; 95% confidence interval [CI] 1.02-8.07; P < 0.05) and the time between diagnosis and the onset of symptoms ‡ 60 days (RR 2.65; 95% CI 0.92-7.59; P < 0.05). Conclusions: Infectious spondylodiscitis affects most frequently the elderly population, who are more exposed to healthcare contacts. Consequently, the infection etiology includes a growing proportion of multi-resistant bacteria and fungi.
Influence of microbiological diagnosis on the clinical course of spondylodiscitis
Infection
Purpose This study sought to recognize differences in clinical disease manifestations of spondylodiscitis depending on the causative bacterial species. Methods We performed an evaluation of all spondylodiscitis cases in our clinic from 2013–2018. 211 patients were included, in whom a causative bacterial pathogen was identified in 80.6% (170/211). We collected the following data; disease complications, comorbidities, laboratory parameters, abscess occurrence, localization of the infection (cervical, thoracic, lumbar, disseminated), length of hospital stay and 30-day mortality rates depending on the causative bacterial species. Differences between bacterial detection in blood culture and intraoperative samples were also recorded. Results The detection rate of bacterial pathogens through intraoperative sampling was 66.3% and could be increased by the results of the blood cultures to a total of 80.6% (n = 170/211). S. aureus was the most frequently detected pathogen in blood culture and...
2012
Spondylodiscitis has gained attention lately because of an alarming and progressive increasing of its incidence, reflecting the rise of percentage of the elderly and immunocompromised people, and the implementation in practice of advanced diagnostic methods. This review will focus on the etiology, diagnostic challenges, and treatment strategies in spondylodiscitis. The incidence of spondylodiscitis is currently 4-24/1 million, making up to 3-5 % of total osteomyelitis cases. It is approximately two times more common in men than in women. Staphylococcus aureus is involved in 48 % 62.5 % of cases of spondylodiscitis. The clinical picture is dominated by spinal pain and stiffness, and increased erythrocytes sedimentation ratio and C-reactive protein are laboratory markers of spondylodiscitis. The most sensitive imaging method is magnetic resonance imaging. Bacteriological examination is very important for proper and effective treatment, guiding the selection of the antibacterial regime...
Infectious spondylodiscitis: A twenty-year experience from a single tertiary referral center
The Egyptian Rheumatologist, 2018
Aim of the work: To study microbiological, clinical and therapeutic aspects of spondylodiscitis (SD) and predisposing risk factors in Tunisian patients. Patients and methods: Patients with SD admitted to Rheumatology Departments, Southern Tunisia, were retrospectively studied. Medical records were reviewed over the last 20-years and investigations included bacterial cultures, magnetic resonance imaging (MRI) or computed-tomography percutaneous disc biopsy (CT-PDB). Results: There were 67 SD cases (incidence of 0.17/100,000 inhabitants/year); 38 men and 29 women and mean age was 55 ± 16 years. Advanced age, tuberculosis and brucellar contagion were the predominant risk factors. The duration from onset to diagnosis was 133.6 ± 115 days. Low back pain (LBP) was the most common symptom. Lumbar spine was the most frequent location. Neurologic symptoms (radicular pain, spinal chord compression, neurologic loss) were observed in 31 patients. C-reactive protein was elevated in 54 (52.17 ± 43.97 mg/L). MRI showed abnormalities in 60 patients and CT-PDB was performed in 39. Pathogens were isolated in 43 cases. Mycobacterium tuberculosis (MT) was the most common (55.8%) followed by staphylococcus aureus (18.6%), brucella (16.3%), Escherichia coli (EC) (4.7%) and streptococcus-b in 1 patient; 1 patient had both MT and EC. Medical treatment was prescribed in 91% and surgery performed in 6. 88% of patients improved after 24 months follow-up. Conclusion: Spondylodiscitis should be considered for all patients presenting with chronic LBP with systemic symptoms and evidence inflammation. MRI is required to establish a diagnosis and evaluate the spread of infection. CT-PDB is useful to identify the causative microorganism before antibiotic administration. These findings could to pave the way for constructing national guidelines.
Monitoring Diagnosis and Treatment of Infectious Spondylodiscitis
The objective of this study was to describe the more consistent findings of pyogenic, brucellar, and tuberculous spondylodis-citis and to improve the early diagnosis and treatment strategies of infectious spondylodiscitis. The etiological distinction of 72 patients was made on the basis of clinical and routine laboratory evaluation, microbiological, histopathological and radiological grounds. The diagnosis of infectious spondylodiscitis was performed by imaging techniques. The patients were diagnosed as tuberculous (28%), brucellar (54%), and pyogenic (18%) spondylodiscitis. The mean age of the patients were 54.7±13.9 years, being 53% as female, and 47% as male. Fever (56.9%), back pain (95.8%), and clinical instability (27.7%) were the predominant symptoms. Erthrocyte sedimentation rate, C-reactive protein, and leukocyte counts were 61.6±31.5 mm/h, 7.2±7.5 mg/dL, and 9000±3906.7 / mm 3 , respectively. The most common location of spondylodiscitis was the lumbar spine (50.0%), followed by lumbosacral (26.4%), and thoracic spine (15.3%). All the patients were treated for at least 12 weeks or longer up to 15 months. Surgery was performed for nine (12.5%) cases. After one-year follow-up of completion therapy, all cases were found to recover without functional sequelae. As presence of characteristic imaging features in the early diagnosis and management of infectious spondylodiscitis, isolation or demonstration of the etiological agent was also essential for monitoring infectious spondylodiscitis.
Infectious spondylodiscitis: has there been any evolution in the diagnostic and treatment outcomes?
Coluna/Columna, 2014
Objective: To evaluate the clinical and radiological results of treatment of patients with spondylodiscitis. Methods: Imaging exams used in this study were plain radiographs and magnetic resonance imaging of the spine. Results: Data from 33 patients, 10 (30.3%) females and 23 (69.7%) males were evaluated. The average time to diagnosis was four months and 28 days (SD ± 1 month and 28 days) and 19 patients (57.5%) presented neurological deficit. Surgical treatment was performed in 22 patients (66.6%) and three patients (9.1%) had complications from the surgery. Conclusions: Despite technological advances in complementary exams, early diagnosis of spondylodiscitis remains a challenge. However, drug treatment associated with surgery shows good results.
Brazilian Journal of Microbiology, 2012
To review the bacteriological features of infectious spondylodiscitis and provide recommendations for the initial therapy which remains empirical in our context. Retrospective study including patients diagnosed with spondylodiscitis over a period of 4 years (2006-2009) at the Rabat Military Teaching Hospital. During the study period, we analysed 30 cases: the mean age was 49.9 years and 21 cases (70%) were male. The patients were predominantly hospitalized in neurosurgery department (15/30) followed by rheumatology department (10/30). The site of infection was lumbar in 21 cases (21/30), dorsal in 7 cases (7/30). 26 cultures were positive of which 19 (19/26) were monomicrobial. Tuberculosis (TB) was implicated in 10 cases (10/30) including 4 cases in association with common organisms (Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis, Corynebacterium species). Brucella melitensis was isolated in 1 case. Infections caused by pyogenic bacteria were isolated in 15 cases of which 12 (12/15) revealed simple organisms including Gram-positive cocci in 9 cases (9/12) with 3 cases of S. aureus and Gram-negative bacilli in 3 cases (3/12) with 2 cases of P. aeruginosa. Blood cultures carried out for 16 patients were positive in 7 cases. The anatomopathologic exams carried out for 20 patients found in 6 cases epithelioid granulomata and giants cells with caseous necrosis in total concordance with TB culture. TB is the most frequent cause of spondylodiscitis in Morocco. Our study found the same frequency for nonspecific and specific germs. Empirical treatment must take into account S. aureus and M. tuberculosis.
Management of Patients with Spondylodiscitis: An Overview
2021
Background:Spinal infections can be described etiologically as pyogenic, granulomatous (tuberculous, brucellar, fungal) and parasitic spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, which are considered different manifestations of the same pathological process; epidural abscess, which can be primary or secondary to spondylodiscitis and facet joint arthropathy.When infection affects the intervertebral disc, the term to describe this condition is usually spondylodiscitis. If invades the endplates or the vertebral body, the infection is more correctly designated for vertebral osteomyelitis or spondylitis. However, at the time of diagnosis in many cases, the infection has already compromised these two structures; therefore, both terms are frequently used.Conservative treatment is the standard of care for patients with spondylodiscitis, using multidisciplinary approaches involving microbiologists, infectious disease consultants, anaesthetists, int...
Spondylodiscitis: update on diagnosis and management
Journal of Antimicrobial Chemotherapy, 2010
Spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, is the main manifestation of haematogenous osteomyelitis in patients aged over 50 years. Staphylococcus aureus is the predominant pathogen, accounting for about half of non-tuberculous cases. Diagnosis is difficult and often delayed or missed due to the rarity of the disease and the high frequency of low back pain in the general population. In this review of the published literature, we found no randomized trials on treatment and studies were too heterogeneous to allow comparison. Improvements in surgical and radiological techniques and the discovery of antimicrobial therapy have transformed the outlook for patients with this condition, but morbidity remains significant. Randomized trials are needed to assess optimal treatment duration, route of administration, and the role of combination therapy and newer agents.
Scientific Reports, 2021
Establishing a multidisciplinary approach regarding the treatment of spondylodiscitis and analyzing its effect compared to a single discipline approach. 361 patients diagnosed with spondylodiscitis were included in this retrospective pre-post intervention study. The treatment strategy was either established by a single discipline approach (n = 149, year 2003-2011) or by a weekly multidisciplinary infections conference (n = 212, year 2013-2018) consisting of at least an orthopedic surgeon, medical microbiologist, infectious disease specialist and pathologist. Recorded data included the surgical and antibiotic strategy, complications leading to operative revision, recovered microorganisms, as well as the total length of hospital and intensive care unit stay. Compared to a single discipline approach, performing the multidisciplinary infections conference led to significant changes in anti-infective and surgical treatment strategies. Patients discussed in the conference showed significantly reduced days of total antibiotic treatment (66 ± 31 vs 104 ± 31, p < 0.001). Moreover, one stage procedures and open transpedicular screw placement were more frequently performed following multidisciplinary discussions, while there were less involved spinal segments in terms of internal fixation as well as an increased use of intervertebral cages instead of autologous bone graft (p < 0.001). Staphylococcus aureus and Staphylococcus epidermidis were the most frequently recovered organisms in both patient groups. No significant difference was found comparing inpatient complications between the two groups or the total in-hospital stay. Implementation of a weekly infections conference is an effective approach to introduce multidisciplinarity into spondylodiscitis management. These conferences significantly altered the treatment plan compared to a single discipline approach. Therefore, we highly recommend the implementation to optimize treatment modalities for patients. Spondylodiscitis, also referred to as vertebral osteomyelitis, is a serious disease with an incidence of 2.2-5.8 per 100.000 and a mortality rate of up to 20% 1. Main treatment goals include the elimination of the infection as well as preservation or restoration of spinal stability and neurological function 1,2. Due to its complexity, diagnosis and treatment of spondylodiscitis remain very challenging and require a coordinated approach 2. Surgical management consists of a wide spectrum of procedures including specimen recovery, debridement of the septic focus, instrumented stabilization, autologous bone graft or cage interposition, vertebral replacement and spinal decompression. Also, the surgical strategies in terms of approach (anterior, posterior or combined), quantity (single-stage or two-stage) and invasiveness (open and percutaneous) need to be defined 1-6. Moreover, complicated by the emergence of highly resistant, Gram-positive and-negative organisms, duration and choice of antimicrobials may be challenging. Furthermore, conservative and additional options such as immobilization, bed rest and physical therapy have to be considered in the treatment plan 2,7,8. Still, the optimal treatment modalities and their indications are controversial and precise recommendations are lacking 1,2,7 .