Infectious Spondylodiscitis: Presentation, Diagnosis and Treatment

Abstract

Introduction: Clinical presentation of spondylodiscitis is heterogeneous. Its diagnosis is sometimes challenging. The authors characterize and evaluate the prevalence of spondylodiscitis in a Department of Internal Medicine (DIM).
Population/Methods: Observational retrospective study of all
patients with spondylodiscitis diagnosis at discharge from
2007 to 2016. Demographic variables, presentation symptoms, risk factors, site of infection, etiology and management
were accessed.
Results: Thirty three cases of spondylodiscitis (19 men, mean
age 77 ± 15.5 years) were identified, performing a prevalence
of 0.3%. The more frequent symptoms at presentation were
flank pain, fever and neurological disorders. Twelve patients
had concomitant infection, eight diabetes mellitus and four
cancer. Four patients undergone surgery < 6 months, three
had chronic hepatic disease and one was an intravenous
drug consumer. Twenty-five patients had elevated leukocyte
count and/or RCP. Twenty-one patients underwent magnetic
resonance imaging (MRI) and computed tomography (CT)
scan, six only MRI, four only CT scan and one only positron
emission tomography. Fifteen patients underwent biopsy.
The most frequent location was the lumbar spine at L4-S1. In
11 patients blood cultures were positive for Escherichia coli
ESBL, Staphylococcus aureus methicillin-resistant (MRSA) or
methicillin-sensitive Staphylococcus aureus (MSSA) and in
one biopsy identified Mycobacterium tuberculosis. The antibiotic scheme was vancomycin and ciprofloxacin for patients
with MRSA and negative cultures, meropenem or piperacillin/
tazobactam and ciprofloxacin for patients with E. coli ESBL,
flucloxacillin for patients with MSSA. The average duration of
treatment was 5 weeks.
Conclusion: Patients with spondylodiscitis are older patients
with co-morbidities. Imagiologic studies are essential for diagnosis as symptoms and laboratory changes may be absent.