Infectious Spondylodiscitis: Presentation, Diagnosis and Treatment
DOI:
https://doi.org/10.24950/rspmi/original/218/2/2018Keywords:
Bacterial Infections/diagnosis, Bacterial Infections/therapy, Discitis/diagnosis, Discitis/therapy, Intervertebral DiscAbstract
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.
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References
Sobottke R, Seifert H, Fatkenheuer G, Schmidt M, Gossmann A, Eysel P. Current diagnosis and treatment of spondylodiscitis. Dtsch Arztebl Int. 2008; 105: 181-7.
Butler JS, Shelly MJ, Timlin M, Powderly WG, O’Byrne JM. Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine. 2006; 31: 2695-2700.
Jensen AG, Espersen F, Skinhoj P, Rosdahl VT, Frimodt-Møller N. Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteriemia in Denmark 1980-1990. J Infect. 1997; 34: 113-8.
Carragee EJ. Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am. 1997; 79: 874-80.
Fantoni M, Trecarichi E, Rossi B, Mazzotta V, Di Giacomo G, Nasto LA, et al. Epidemiological and clinical features of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012; 16: 2-7.
Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother. 2010; 65: 11-24.
Turunc T, Demiroglu YZ, Uncu H, Colakoglu S, Arslan H. A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect. 2007; 55: 158-63.
Citak M, Backhaus M, Kalicke T, Hilal Z, Muhr G, Frangen TM, et al. Myths and facts of spondylodiscitis: An analysis of 183 cases. Acta Orthop Belg. 2011; 77:535.
Beronius M, Bergman B, Andersson R. Vertebral osteomyelitis in Goteborg, Sweeden: a retrospective study of patients during 1990-95. Scand J Infect Dis. 2001; 33: 527-32.
Tyrrell PN, Cassar-Pullicino VN, McCall IW. Spinal Infection. Eur Radiol 1999; 9: 1066-077.
Friedman JA, Maher CO, Quast LM, McClelland RL, Ebersold MJ. Spontaneous disc space infections in adults. Surg Neurol. 2002; 57:81-6.
Kapsalaki E, Gatselis N, Stefos A, Makaritsis K, Vassiou A, Fezoulidis I, , et al. Spontaneous spondylodiscitis: presentation, risk factors, diagnosis, management and outcome. Int J Infect Dis. 2009; 13: 564-9.
Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 2009; 39: 10-7
Krogsgaard MR, Wagn P, Bengtsson J. Epidemiology of acute vertebral osteomyelitis in Denmark: 137 cases in Denmark 1978-1982, compared to caes reported to the National Patient Register 1991-1993. Acta Orthop Scand. 1998; 69: 513-7.
Modic MT, Feiglin DH, Piraino DW, Boumphrey F, Weinstein MA, Duchesneau PM, et al. Vertebral osteomyelitis: assessment using MR. Radiology. 1985; 157: 157-66.
Glaudemans AW, de Vries EF, Galli F, Dierckx RA, Slart RH, Signore A. The use of (18) F-FDG-PET/CT for diagnosis and treatment monitoring of inflammatory and infectious diseases. Clin Dev Immunol 2013: 2013: 623036.
Stumpe KD, Zanetti M, Weishaupt D, Hodler J, Boos N, Von Schulthess GK. FDG positron emission topography for differentiation of degenerative and infectious endplate abnormalities in the lumbar spine detected on MR imaging. AJR Am J Roentgenol. 2002; 179: 1151-7.
Georgakopoulos A, Pneumaticos SG, Sipsas NV, Chatziioannou S. Positron emission tomography in spinal infections. Clin Imaging. 2015; 39:553-8.
Daghighi MH, Poureisa M, Safarpour M, Behzadmehr R, Fouladi DF, Meshkini A, et al. Diffusion-weighted magnetic resonance imaging in differentiating acute infectious spondylitis from degenerative Modic type 1 change; the role of value, apparent diffusion coefficient, claw sign and amorphous increased signal. Br J Radiol. 2016; 89: 20150152.
Chelsom J, Solberg CO. Vertebral osteomyelitis at a Norwegian university hospital 1987-97: clinical features, laboratory findings and outcome. Scand J Infect Dis. 1998; 30: 147-51.
Beronius M, Bergman B, Andersson R. Vertebral osteomyelitis in Goteborg, Sweeden: a retrospective study of patients during 1990-95. Scand J Infect Dis. 2001; 33: 527-32.
Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, et al. Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis. 2015; 61:859-63.
Belzunegui J, Intxausti JJ, De Dios JR, Del Val N, Rodríguez Valverde V, et al. Haematogenous vertebral osteomyelitis in the eldery. Clin Rheumatol. 2000; 19: 344-7.
Capelo J, Carragoso A, Albuquerque C, Mocho ML, Canto-Moreira N. Espondilite infecciosa: o estudo de quarenta e um casos. Acta Reumatol Port. 2007; 32:255-62.
Lebre A, Velez J, Seixas D. Espondilodiscite brucélica: casuística dos últimos 25 anos. Acta Med Port. 2014;27:204-10.
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