Abstract
The goal of this work is to evaluate the epidemiology and treatment employed in the treatment of pyogenic spondylodiscitis.
Diagnosis was based on clinical and imaging, it does not include cases of postoperative infection and lesions contiguous with decubitus ulcers. The clinical records were used to obtain demography, comorbidities, presenting symptoms, physical examination, laboratorial values, diagnostic procedures, microbiological profile as well as medical and surgical treatment. Statistical analysis was performed using SPSS 20.
After reviewing 22 patients met the inclusion criteria. The mean age was 60.82(range 22–86), 82 % were men(n=18). Most prevalent comorbidities were diabetes mellitus 41%(n=9), chronic alcoholism 18% (n=4), CKD 14%(n=3) and HIV in 9%(n=2). Approximately 40.1% had a septic focus in another location, the most common UTI 30%(n=3) and 20% sepsis(n=2). The most common symptoms were LBP 51%(n=21), weight loss 15%(n=6) and fever 12%(n=5). Laboratory evaluation revealed an average leukocytosis 11.8(range 4.3–21.8), ESR averaged 83.9 mm/h (range 10–128), mean CRP 11.6 mg/dl(range 0.4–38.7). The lumbar spine was the most affected segment 55%(n=12), then the dorsal 36%(n=8) and cervical 9%(n=2). The microbiological diagnosis was established in 55% of cases (n=12), 8(66.7%) cases were identified in blood cultures and 3(25%) in bone biopsy. The most common agents identified were MSSA in 18% of cases (n=4) and cogulase negative staphylococci 18%(n=4). A surgical procedure was performed in 86.4% (n=19), 7 for fusion and in 4 a transpedicular biopsy. The indications for surgery were crop material, abscess drainage and instability each with 32%(n=6). In terms of neurological sequelae 23%(n=5) had changes. The average length of stay was 57.4 days(range 19–190), mortality was 9%(n=2). We found no statistically significant differences regarding the identification of microorganisms using age (p=0.644), ESR(p=0.233), CRP(p=0.166) and leukocytosis(p=0.147) as variables.
Our series has characteristics common to literature, predominantly male, risk factors as Diabetes, CKD and HIV are common. Alcoholism is linked with some immunosuppression and appears as a new risk factor. Obtaining microbiological diagnosis is crucial to avoid the need for prolonged antibiotic therapy and the potential increased costs and toxicity of broad spectrum. The low number of positive biopsy (25%) is explained by the early empirical antibiotic therapy before sampling. Surgery plays an important role in crop products for microbiological analysis and treatment of instability or neurological deficits. A high index of suspicion in patients with known risk factors and back pain is crucial since delay in diagnosis leads to worse outcomes.
