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Cadiou S, Tuil R, Le Goff B, Hoppé E, Mulleman D, Langbour C, Le Pabic E, Charret L, Cormier H, Lecomte R, Arvieux C, Guggenbuhl P. Septic arthritis of the facet joint is also a severe vertebral infection: A multicenter retrospective study of 65 patients. Joint Bone Spine 2024; 91:105703. [PMID: 38336272 DOI: 10.1016/j.jbspin.2024.105703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Septic arthritis of the Facet Joints (SAFJ) is a rare condition. Little data has been published on the subject. We aimed to describe the clinical, biological and imagery presentations, as well as the course of this rare infection. METHODS We included patients hospitalized between January 1st, 2016 and December 31th, 2019, in the Departments of Infectious Diseases or Rheumatology in 5 French centres in the CRIOGO network. We defined septic arthritis according to Newman's criteria and facet joint arthritis using imagery. RESULTS Sixty-five patients were included, predominantly males (64.6%), with a mean age of 68.1 years. The mean time to diagnosis was 25.0 days. The principal symptoms at diagnosis were acute back pain (95.2%) and fever (76.9%). Neurological symptoms were present for 60.7% of the patients, including 16.4% motor deficit or cauda equina syndrome. SAFJ was located on the lumbosacral spine (73.4%) and was rarely multifocal (4.7%). Bacteriological identification was performed by blood cultures in 84.4% of the cases, and the pathogen was mainly Staphylococcus aureus (49.2%). Infective endocarditis was present for 26.9% of patients assessed by echocardiography. On MRI, soft tissue abscess or inflammation, epiduritis and epidural abscess were present in 87.1%, 66.7% and 33.9% of cases, and the pathogen was significantly more frequently Staphylococcus aureus. Mortality reached 9.2%, 18.5% and 23% at one, two, and three years respectively. CONCLUSION SAFJ is a rare but severe disease. Microbiological diagnosis is primarily made on blood cultures, and S. Aureus was the main pathogen. Our results highlight the fact that SAFJ is associated with high morbidity and mortality, and with infective endocarditis.
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Affiliation(s)
- Simon Cadiou
- Department of Rheumatology, Rennes University Hospital, Rennes, France.
| | - Rachel Tuil
- Department of Rheumatology, Rennes University Hospital, Rennes, France; Rennes University, Faculty of Medicine, Rennes, France
| | - Benoît Le Goff
- Regenerative Medicine and Skeleton, RMeS, UMR 1229, Oniris, Inserm, Nantes university, Nantes, France; Department of Rheumatology, Nantes University Hospital, Nantes, France
| | - Emmanuel Hoppé
- Department of Rheumatology, Angers University Hospital, Angers, France
| | - Denis Mulleman
- Department of Rheumatology, Tours University Hospital, University of Tours, Tours, France
| | - Camille Langbour
- Department of Rheumatology, Tours University Hospital, University of Tours, Tours, France
| | - Estelle Le Pabic
- Inserm, CIC UMR 1414, Rennes University Hospital, Rennes University, Rennes, France
| | - Laurie Charret
- Rheumatology Department, Hospital of Vendée, La Roche-Sur-Yon, France
| | - Helene Cormier
- Department of Infectious Diseases, Angers University Hospital, Angers, France
| | - Raphael Lecomte
- Department of Infectious Diseases, Centre d'Investigation Clinique 1413, Inserm, University Hospital of Nantes, Nantes, France
| | - Cédric Arvieux
- Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France
| | - Pascal Guggenbuhl
- Department of Rheumatology, Rennes University Hospital, Rennes, France; University of Rennes, Inserm, INRAE, CHU of Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes, France
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Chevalerias M, Coiffier G, Darrieutort-Laffite C, Godot S, Ottaviani S, Henry J, Brochard J, Cormier G, Couderc M, Hoppe E, Mulleman D, Khatchatourian L, Le Thuaut A, Bart G, Le Goff B. Association between radiographic and functional outcome in vertebral osteomyelitis SPONDIMMO, a 6-month prospective multicenter cohort. Joint Bone Spine 2023; 90:105600. [PMID: 37330001 DOI: 10.1016/j.jbspin.2023.105600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES This study aimed to describe radiographic and functional evolution over 6 months in a large cohort of VO patients. METHODS We prospectively recruited patients with VO from 2016 to 2019 in 11 French centers. X-rays were performed at baseline, 3 months, and 6 months to assess progression using structural and static criteria. Functional impairment was evaluated using the Oswestry Disability Index (ODI) at 3 months and 6 months. RESULTS Two hundred and twenty-two patients were included. Mean age was 67.8±14 years, mostly men (67.6%). After 3 months, there was a significant increase in vertebral fusion (16.4% vs 52.7%), destruction of vertebral bodies (10.1% vs 22.8%), and of all the static features (frontal angulation (15.2% vs 24.4%), segmental (34.6% vs 56%) and regional (24.5% vs 41%) kyphosis). From 3 to 6 months, among the different X-ray abnormalities, only the complete fusion progressed significantly (16.6% vs 27.2%). Median ODI showed significant improvement from 3 to 6 months (24, IQR [11.5-38] vs 16, IQR [6-34]). At 6 months, 14.1% of the patients had a severe disability, 2% a major disability. The persistence of vertebral destruction at 6 months was associated with a higher ODI (16, IQR [7.5-30.5] vs 27, IQR [11.5-44.5]). No differences in radiological progression were observed with immobilization using a rigid brace. CONCLUSION Our study demonstrates structural and static radiographic progression after 3 months. Only the complete fusion progressed over the long-term. Functional impairment was associated with persistence of vertebral destruction.
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Affiliation(s)
| | | | | | - Sophie Godot
- Department of Rheumatology, AP-HP DCSS, Paris, France
| | | | - Julien Henry
- Department of Rheumatology, AP-HP Bicêtre, Paris, France
| | - Julia Brochard
- Department of Infectious Diseases, CH de Saint-Nazaire, Saint-Nazaire, France
| | - Grégoire Cormier
- Department of Rheumatology, CHD de Vendée, La Roche-sur-Yon, France
| | - Marion Couderc
- Department of Rheumatology, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Hoppe
- Department of Rheumatology, CHU d'Angers, Angers, France
| | | | - Lydie Khatchatourian
- Department of Internal Medicine and Infectious Disease, CH de Cornouaille, Quimper, France
| | - Aurélie Le Thuaut
- Direction of Research, Methodology and Biostatistics Platform, CHU de Nantes, Nantes, France
| | - Géraldine Bart
- Department of Rheumatology and Internal Medicine, Percy Military Training Hospital, Paris, France
| | - Benoit Le Goff
- Department of Rheumatology, CHU de Nantes, Nantes, France
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de Nettancourt A, Derdevet J, Dahmane L, Jaffal K, Perronne V, Tordjman M, Noussair L, Dinh A. [A vertebral polymicrobial osteomyelitis with atypicial microorganisms: A case report]. Rev Med Interne 2023; 44:190-194. [PMID: 36775692 DOI: 10.1016/j.revmed.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/10/2022] [Accepted: 01/08/2023] [Indexed: 02/12/2023]
Abstract
Vertebral Osteomyelitis (VO) is a rare disease, which has seen a gradual increase in its incidence over the past years. Here, we report a case, showing how difficult it can be to diagnose and manage a therapy in case of atypical microorganism. A 68-year-old man was hospitalized for a VO documented by blood cultures at Bacteroides fragilis. He first progressed favorably, but an increase in lumbar pain prompted, after an IRM, a percutaneous needle biopsy (PNB) that documented a recurrent VO at Corynebacterium striatum. In the face of this multi-microbial VO with atypicals microorganisms, a first PNB could have been discussed despite the positive blood cultures. This case report illustrates the complexity of management of VO, and its evolution according to the latest recommendations (interest of RMI during the follow-up, place of the TEP-scan, terms and conditions of immobilization, antibiotic administration methods).
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Affiliation(s)
- A de Nettancourt
- Service de maladies infectieuses et tropicales, hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - J Derdevet
- Service de maladies infectieuses et tropicales, hôpital Raymond-Poincaré, AP-HP, Garches, France.
| | - L Dahmane
- Service de maladies infectieuses et tropicales, hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - K Jaffal
- Service de maladies infectieuses et tropicales, hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - V Perronne
- Service de maladies infectieuses et tropicales, hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - M Tordjman
- Service de radiologie, hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - L Noussair
- Service de microbiologie, hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - A Dinh
- Service de maladies infectieuses et tropicales, hôpital Raymond-Poincaré, AP-HP, Garches, France
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