1
|
Yagdiran A, Paul G, Meyer-Schwickerath C, Scheder-Bieschin J, Tobys D, Kernich N, Eysel P, Jung N. Clinical features and outcome of vertebral osteomyelitis after spinal injection: is it worth the price? Infection 2023; 51:599-607. [PMID: 37071309 DOI: 10.1007/s15010-023-02024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Spinal injections are increasingly used for back pain treatment. Vertebral osteomyelitis (VO) after spinal injection (SIVO) is rare, but patient characteristics and outcome have not been well characterized. The aim of this study was to assess patient characteristics of SIVO in comparison to patients with native vertebral osteomyelitis (NVO) and to determine predictors for 1-year survival. METHODS This is a single-center cohort study from a tertiary referral hospital. This is a retrospective analysis of Patients with VO who were prospectively enrolled into a spine registry from 2008 to 2019. Student's t-test, Kruskal-Wallis test or Chi-square test were applied for group comparisons. Survival analysis was performed using a log-rank test and a multivariable Cox regression model. RESULTS 283 VO patients were enrolled in the study, of whom 44 (15.5%) had SIVO and 239 (84.5%) NVO. Patients with SIVO were significantly younger, had a lower Charlson comorbidity index and a shorter hospital stay compared to NVO. They also showed a higher rate of psoas abscesses and spinal empyema (38.6% [SIVO] vs. 20.9% [NVO]). Staphylococcus aureus (27%) and coagulase-negative staphylococci (CNS) (25%) were equally often detected in SIVO while S. aureus was more frequently than CNS in NVO (38.1% vs. 7.9%).Patients with SIVO (P = 0.04) had a higher 1-year survival rate (Fig. 1). After multivariate analysis, ASA score was associated with a lower 1-year survival in VO. CONCLUSION The results from this study emphasize unique clinical features of SIVO, which warrant that SIVO should be estimated as a separate entity of VO.
Collapse
Affiliation(s)
- Ayla Yagdiran
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Gregor Paul
- Department of Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.
| | | | - Justus Scheder-Bieschin
- Department of Interdisciplinary Acute, Emergency and Intensive Care Medicine (DIANI), Klinikum Stuttgart, Stuttgart, Germany
| | - David Tobys
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nikolaus Kernich
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Norma Jung
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| |
Collapse
|
2
|
Both A, Christner M, Berinson B, Dreimann M, Viezens L, Lütgehetmann M, Aepfelbacher M, Rohde H, Stangenberg M. The added value of a commercial 16S/18S-PCR assay (UMD-SelectNA, Molzym) for microbiological diagnosis of spondylodiscitis: an observational study. Diagn Microbiol Infect Dis 2023; 106:115926. [PMID: 36963329 DOI: 10.1016/j.diagmicrobio.2023.115926] [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: 09/27/2022] [Revised: 02/14/2023] [Accepted: 02/19/2023] [Indexed: 03/26/2023]
Abstract
In spondylodiscitis, pathogen identification is important to guide therapy strategies. Here the use of an rDNA PCR assay (Molzym UMDSelectNA) for pathogen detection in spondylodiscitis was evaluated in 182 specimens from 124 spondylodiscitis patients. In 81% of specimens rDNA PCR and conventional culture produced concordant results. Compared to conventional culture, sensitivity and specificity of rDNA PCR were 75% and 83.9%, respectively. The rDNA PCR performed better than conventional culture in identification of Streptococcus spp.. However, overall sensitivity was suboptimal, e.g., in cases with low bacterial burden, and only 5 of 124 patients (4%) received a microbiological diagnosis by employing rDNA PCR. Thus, the added value of routine use of rDNA PCR on spondylodiscitis specimens is limited. Targeted use of the assay in culture-negative cases may be efficient and moderately increase diagnostic yield. The need for susceptibility information implies that 16S rDNA PCR may only be used as an add-on tool to culture.
Collapse
Affiliation(s)
- Anna Both
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Christner
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Berinson
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Dreimann
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Lennart Viezens
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Aepfelbacher
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Rohde
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
| | - Martin Stangenberg
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| |
Collapse
|
3
|
Mirbagheri A, Etminan N, Schölch S, Maier C, Perrin J, Enders F. Lumbar Spondylodiscitis Mimicking Cholecystitis: A Case Report and Review of Literature. J Neurol Surg A Cent Eur Neurosurg 2023; 84:95-102. [PMID: 35354214 DOI: 10.1055/a-1811-7393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Lower back pain is a frequent cause of emergency department visits and one of the leading causes of the disease burden worldwide. The purpose of this case report and literature review was to discuss atypical abdominal entities mimicking spinal diseases typically presenting with lower back pain. METHODS A 79-year-old man presented with lower back pain and urinary incontinence after receiving a non-image-guided lumbar infiltration treatment 4 weeks prior to admission. The magnetic resonance imaging (MRI) highlighted multisegmental hyperintensities in the intervertebral disk spaces of the lumbar spine indicative for spondylodiscitis. Antibiotic treatment over a week did not lead to significant clinical improvement. Blood cultures, cardiologic, otorhinolaryngologic, and dental examinations turned out negative for a focus of infection. A computed tomography (CT) guided biopsy was indicated after discontinuation of antibiotic treatment for less than 24 hours. Rapid clinical deterioration with concomitant onset of abdominal pain resulted in the diagnosis of cholecystitis, which required cholecystectomy. We performed a systematic literature review using the Pubmed database for the keywords "spondylodiscitis," "spine," "abdominal," and "cholecystitis," to identify abdominal diseases that mimic spine pathologies and spinal diseases that mimic abdominal pathologies. RESULTS No other report in English literature of cholecystitis associated with initial onset of lower back pain was identified. Eighteen reports referred to abdominal conditions that mimic spinal diseases, among them a patient with cyclic lumbar back pain who received a lumbar spinal fusion who, after persisting symptoms led to further diagnostic procedures, was ultimately diagnosed with endometriosis. Spinal symptoms included paraplegia and urinary incontinence as results of acute aortic pathologies. Eleven reports presented spinal pain mimicking abdominal conditions including abdominal pain and diarrhea as well as have had surgical procedures such as an appendectomy before the spinal condition was discovered. CONCLUSION Clinical symptoms of the spine such as lower back pain can be unspecific and lead to false conclusions in the presence of concomitant pathologies in MRI. Only clinical deterioration in our case patient prompted correction of the diagnosis on day 7. Initial workup for alternative common infectious foci such as lung and urinary tract was performed, but further abdominal workup despite the absence of abdominal symptoms may have led to an earlier diagnosis. Our literature review found several cases of misdiagnosed spinal and abdominal conditions. Some had undergone unnecessary surgical procedures before the right diagnosis was made. Because of the high incidence of symptoms such as lumbar back pain and abdominal pain, considering optimal patient care as well as economic aspects, it would be essential to conduct an interdisciplinary clinical management to avoid errors in the early stage of diagnostics.
Collapse
Affiliation(s)
- Andia Mirbagheri
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sebastian Schölch
- Junior Clinical Cooperation Unit Translational Surgical Oncology (A430), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Surgery, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christopher Maier
- Junior Clinical Cooperation Unit Translational Surgical Oncology (A430), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Surgery, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jason Perrin
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frederik Enders
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
4
|
Heyde CE, Spiegl UJA, Voelker A, von der Hoeh N, Henkelmann J. Imaging in the Diagnosis of Nonspecific Pyogenic Spondylodiskitis. J Neurol Surg A Cent Eur Neurosurg 2023; 84:69-76. [PMID: 32911551 DOI: 10.1055/s-0040-1709168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The prevalence of nonspecific pyogenic spondylodiskitis, associated with both a high morbidity and a high mortality, has increased in the last few decades. The diagnosis is often delayed because of the nonspecific clinical manifestation at the early stage. The reliability of radiographs is limited, particularly in early stage after the onset of infection. Computed tomography (CT) can reliably assess the bony condition with the possibility of spatial visualization. Contrast enhancement supports the detection of affected soft tissue. Magnetic resonance imaging (MRI) continues to be the gold standard in the diagnosis of spondylodiskitis. Sophisticated investigation protocols supported by gadolinium enhancement secure the diagnosis. MRI has a high resolution without radiation exposure. Different nuclear investigation techniques extend the diagnostic options. Reports of 18F-fluorodeoxyglucose-positron emission tomography (18-FDG-PET) are particularly promising to confirm the diagnosis. The drawback of the reduced image quality with respect to detailed anatomical information can be overcome by a combined simultaneous acquisition of CT or MRI. With respect to one of the greatest challenges, the differentiation between degenerative changes (Modic type 1) and infection at an early stage using differentiated MRI protocols and FDG-PET is promising. This overview presents a concise state-of-the-art look at radiologic investigations in case of suspected nonspecific pyogenic spondylodiskitis with the focus on a pragmatic approach.
Collapse
Affiliation(s)
- Christoph Eckhard Heyde
- Department of Orthopedics, Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | | | - Anna Voelker
- Department of Orthopedics, Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | - Nicolas von der Hoeh
- Department of Orthopedics, Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | | |
Collapse
|
5
|
Irshad M, Mahmood SF. Extended drug-resistant Salmonella typhi osteomyelitis: a case report and literature review. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Salmonella typhi infection commonly results in gastroenteritis, bacteremia with or without secondary seeding, or asymptomatic carrier stage. Few cases of Salmonella typhi bacteremia later result in seeding and ultimately lead to further complications including osteomyelitis and rarely vertebral osteomyelitis.
Case presentation
We are discussing a case of a 38-year-old Asian male patient, with no known comorbids. He presented with fever and backache for 4 weeks. Based on the magnetic resonance imaging (MRI) findings of the spine and positive blood cultures, a diagnosis of XDR Salmonella typhi (S. typhi) osteomyelitis (OM) was made. Patient was started on intravenous therapy as per culture report which was later modified according to treatment response.
Conclusion
S. typhi has a broad spectrum of clinical manifestations including osteomyelitis however to the best of our knowledge this is the first reported case of XDR S. typhi vertebral osteomyelitis. We describe the clinical course of the patient and review the literature regarding the treatment of S.typhi vertebral osteomyelitis with a special focus on XDR S. typhi. Treatment course and complications in view of this new resistant strain have to be reported in order to devise general guidelines for the management in such particular cases.
Collapse
|
6
|
González-Martín M, Silva V, Poeta P, Corbera JA, Tejedor-Junco MT. Microbiological aspects of osteomyelitis in veterinary medicine: drawing parallels to the infection in human medicine. Vet Q 2022; 42:1-11. [PMID: 34936853 PMCID: PMC8725753 DOI: 10.1080/01652176.2021.2022244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/22/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
Osteomyelitis is a challenging infectious disease affecting humans and animals. It is difficult to diagnose because, in many cases, symptoms are non-specific and, for example in implant-related cases, can appear long time after surgery. In addition to this, it is also difficult to treat due to the need to find the appropriate antibiotic regime and delivery system to reach the site of infection and to avoid development of bacterial resistance. The central purpose of this review is to compare the microbiological aspects of osteomyelitis in human and veterinary medicine, with the aim of improving the microbiological diagnosis and treatment of this infection in animals. Furthermore, the study of osteomyelitis in animals may help to improve the development of animal models for testing new treatments in humans. Host factors and underlying conditions have been studied mainly in humans, although aspects as immunodeficiency have been described in some veterinary cases. Even when Staphylococcus aureus is still considered the most prevalent causing microorganism, this prevalence should be reviewed using molecular diagnostic techniques, and this could affect treatment options. New approaches to treatment include local delivery of antibiotics using different biomaterials, antimicrobial photodynamic therapy, and new antimicrobial compounds. We would like to remark the need of large, high-quality clinical trials and of the development of guides for the diagnosis and treatment of osteomyelitis in different animal species.
Collapse
Affiliation(s)
- Margarita González-Martín
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain
- Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Vanessa Silva
- Microbiology and Antibiotic Resistance Team (MicroART), Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal
- Associated Laboratory for Green Chemistry (LAQV-REQUIMTE), University NOVA of Lisboa, Caparica, Portugal
- Veterinary and Animal Research Centre, Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal
| | - Patricia Poeta
- Microbiology and Antibiotic Resistance Team (MicroART), Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal
- Associated Laboratory for Green Chemistry (LAQV-REQUIMTE), University NOVA of Lisboa, Caparica, Portugal
- Veterinary and Animal Research Centre, Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal
| | - Juan Alberto Corbera
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain
- Department of Animal Pathology, Animal Production and Food Science and Technology, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - María Teresa Tejedor-Junco
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain
- Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain
| |
Collapse
|
7
|
Hwang JH, Lee SY, Lee J, Hwang JH. Pyogenic spondylitis caused by Klebsiella pneumoniae: should the possibility of hypervirulent Klebsiella pneumoniae be considered? BMC Infect Dis 2022; 22:801. [PMID: 36303118 PMCID: PMC9615223 DOI: 10.1186/s12879-022-07785-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 05/31/2023] Open
Abstract
Background Klebsiella pneumoniae is rare but the second most common causative agent among gram-negative bacteria that cause pyogenic spondylitis. However, there are no available studies on the serotype, virulence factors, and clinical characteristics associated with K. pneumoniae-caused pyogenic spondylitis. Accordingly, we investigated the clinical characteristics of pyogenic spondylitis, K1 and K2 serotypes, and virulence factors of K. pneumoniae. Methods We reviewed the microbiological reports of specimens collected between January 2014 and December 2019 as well as the medical records of patients with pyogenic spondylitis caused by K. pneumoniae. We also evaluated K1 and K2 serotypes and the virulent genes rmpA, iutA, mrkD, ybtS, entB, and kfu. Strains that possessed rmpA and iutA were defined as hypervirulent K. pneumoniae. Results Six patients with pyogenic spondylitis caused by K. pneumoniae were enrolled in the study. The capsular serotypes K1 and K2 were present in 66.7% (4/6) of cases, and the hypervirulent strains were present in 88.3% (5/6) of cases. All patients had community-acquired infections, and all strains isolated were susceptible to antimicrobial agents. Intravenous antibiotic treatment continued for 2–7 weeks, and no patient underwent decompressive operation or surgical debridement. There was no recurrence. One patient died from pneumonia with a septic lung. Conclusion Hypervirulent K. pneumoniae is a rare but possible causative agent associated with pyogenic spondylitis.
Collapse
Affiliation(s)
- Joo-Hee Hwang
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea.,Research Institute of Clinical Medicine, Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea
| | - Seung Yeob Lee
- Research Institute of Clinical Medicine, Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea.,Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea
| | - Jaehyeon Lee
- Research Institute of Clinical Medicine, Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea. .,Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea.
| | - Jeong-Hwan Hwang
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea. .,Research Institute of Clinical Medicine, Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea.
| |
Collapse
|
8
|
Riaz T, Howard M, Diehn F, Tande A, Ross C, Huddleston P, Berbari E. Utility of disc space aspirate cell counts and differentials in the diagnosis of native vertebral osteomyelitis. J Bone Jt Infect 2022; 7:213-219. [PMID: 36415688 PMCID: PMC9673032 DOI: 10.5194/jbji-7-213-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/26/2022] [Indexed: 09/01/2023] Open
Abstract
Background: Aspiration of intervertebral disc space is often done to confirm the diagnosis of native vertebral osteomyelitis. A study has not been done examining the utility of cell counts and differentials of the aspirated fluid in diagnosing native vertebral osteomyelitis (NVO). Methods: In this feasibility study, we prospectively enrolled patients with a suspected diagnosis of NVO referred to the Division of Neuroradiology for image-guided needle aspiration of the intervertebral disc. In this study, manual cell count was done on the aspirated fluid, followed by a differential cytospin technique and touch prep. We obtained demographic, lab, and microbiologic data and used the receiver operating curve (ROC) for statistical analysis. Results: Over 12 months, we performed 17 aspirates on 14 patients. The median age was 70.5 years (range: 45-77). The median manual cell count on the aspirated fluid was 52 cells µ L - 1 (range: 0-6656), the median neutrophil percentage on the touch prep slide was 73 % (range: 5 %-100 %), and the median neutrophil percentage on the cytospin slide was 82 % (range: 0 %-100 %). Routine bacterial cultures were positive in five cases, and the 16S ribosomal RNA gene polymerase chain reaction was positive in two cases. The optimal cutoff for a cell count of 104 total nucleated cells offered a sensitivity and specificity of 86 %, and a neutrophil cutoff of 83 % was associated with a 71 % sensitivity and specificity. Conclusion: An image-guided aspirated specimen leukocyte differential of ≥ 83 % neutrophils or a leukocyte count of ≥ 104 µ L - 1 was a sensitive and specific test for diagnosing patients with suspected NVO. Additionally, more extensive studies are warranted to confirm the findings.
Collapse
Affiliation(s)
- Talha Riaz
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota,
USA
- Division of Infectious Diseases, University of Arizona Medical Center,
Tucson, Arizona, USA
| | - Matthew Howard
- Division of Pathology and Laboratory Medicine, Mayo Clinic, Rochester,
Minnesota, USA
| | - Felix Diehn
- Division of Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Courtney Ross
- Division of Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul Huddleston
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota,
USA
| | - Elie Berbari
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota,
USA
| |
Collapse
|
9
|
Starnes LS, Krehnbrink M, Carroll AR, Brown C. A Pain in the Neck: An Adolescent with Neck Pain. Pediatr Rev 2022; 43:174-177. [PMID: 35229110 PMCID: PMC8996527 DOI: 10.1542/pir.2020-004168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Alison R Carroll
- Division of Pediatric Hospital Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN
| | - Charlotte Brown
- Division of Pediatric Hospital Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN
| |
Collapse
|
10
|
Brinkmann J, Zeißler EC, Scharrenberg JS, Schenk J, Majjouti M, Oberste M, Yagdiran A, Scheyerer MJ, Jung N, Siewe J, Mahabir E. The diagnostic value of cytokines for the discrimination of vertebral osteomyelitis and degenerative diseases of the spine. Cytokine 2021; 150:155782. [PMID: 34933239 DOI: 10.1016/j.cyto.2021.155782] [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: 06/22/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 11/03/2022]
Abstract
Vertebral osteomyelitis (VO) is a primary infection of the endplates of the vertebral bodies with secondary infection of the adjacent intervertebral discs. Diagnosis is often delayed due to unspecific symptoms and a lack of specific infection markers. In this prospective study, we determined the suitability of 27 cytokines for the discrimination of VO and degenerative diseases of the spine and compared its diagnostic potential in relation to the C-reactive protein (CRP), which is widely used as a non-specific inflammation marker in clinical diagnostics. The patients included in this study underwent surgical stabilization of the lumbar and/or thoracic spine with removal of 1 or more affected intervertebral discs, as therapy for VO (n = 16) or for erosive osteochondrosis (EO, control group, n = 20). We evaluated the cytokine and CRP concentrations before (pre-OP = -20-0d where 0 means the day of surgery) and after surgery (post-OP) on days 3-5, 6-11, 40-56, and 63-142. Compared to the control patients pre-OP, a significantly higher elevation of the 4 cytokines IL-6, IL-8, IL-12 (p70), and VEGF as well as CRP were found in the VO patients, showing an area under the curve > 0.80 pre-OP. No significant differences were observed between VO patients with high and low virulent bacteria with respect to all 5 elevated biomarkers. This is the first prospective study in which a broad spectrum of 27 cytokines was analysed via multiplex assay using sera from patients with and without VO. Our results show that, in addition to CRP, 4 different cytokines were significantly altered in VO but not control patients. The results implicate that these candidate cytokines may be used in a multiplex assay for discrimination between VO and degenerative diseases of the spine.
Collapse
Affiliation(s)
- Julia Brinkmann
- Comparative Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany
| | - Eva-Carina Zeißler
- Comparative Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany
| | - Jan Simon Scharrenberg
- Comparative Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany
| | - Julia Schenk
- Comparative Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany
| | - Mohamed Majjouti
- Comparative Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany
| | - Max Oberste
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 10, 50931 Cologne, Germany
| | - Ayla Yagdiran
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Kerpener Straße 62, 50937 Cologne, Germany
| | - Max J Scheyerer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Kerpener Straße 62, 50937 Cologne, Germany
| | - Norma Jung
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Kerpener Straße 62, 50937 Cologne, Germany
| | - Jan Siewe
- Faculty of Medicine and University Hospital of Cologne, Joseph-Stelzmann-Straße 20, 50931 Cologne, Germany
| | - Esther Mahabir
- Comparative Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany.
| |
Collapse
|
11
|
Bousfield R, Ramsay I, Warne B, Kotecha D, Mitchell T, Sandoe J, Moore E, Nickerson E, Kirby A, Enoch D. A retrospective cohort study of bacterial native vertebral osteomyelitis and its management in the UK. CLINICAL INFECTION IN PRACTICE 2021. [DOI: 10.1016/j.clinpr.2021.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
12
|
Comparison of serum procalcitonin and interleukin-6 levels with CRP levels in the follow-up of antimicrobial treatment of patients with pyogenic and granulomatous vertebral osteomyelitis. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.953034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
13
|
Pojskić M, Carl B, Schmöckel V, Völlger B, Nimsky C, Saβ B. Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis. Brain Sci 2021; 11:brainsci11081019. [PMID: 34439638 PMCID: PMC8394582 DOI: 10.3390/brainsci11081019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/16/2021] [Accepted: 07/23/2021] [Indexed: 12/19/2022] Open
Abstract
Surgical treatment of spondylodiscitis allows for rapid mobilization and shortens hospital stays, which makes surgical treatment the first-line therapy. We aim to describe our experiences with operative treatment on spondylodiscitis and to determine the parameters that are important in the prediction of outcomes. A retrospective review identified 237 patients who were operatively treated for spondylodiscitis in our institution between January 2010 and December 2018. Clinical data were collected through review of electronic records and relevant imaging. In all cases, contrast-enhancing MRI from the infected region of the spine was obtained. Leukocyte count and C-reactive protein concentrations (CRP) were determined in all the patients. We included 237 patients in the study, 87 female (36.7%) and 150 male (63.3%), with a mean age of 71.4 years. Mean follow-up was 31.6 months. Forty-five patients had spondylodiscitis of the cervical, 73 of the thoracic, and 119 of the lumbosacral spine. All the patients with spondylodiscitis of the cervical spine received instrumentation. In thoracic and lumbar spine decompression, surgery without instrumentation was performed in 26 patients as immediate surgery and in a further 28 patients in the early stages following admission, while 138 patients received instrumentation. Eighty-nine patients (37.6%) had concomitant infections. Infection healing occurred in 89% of patients. Favorable outcomes were noted in patients without concomitant infections, with a normalized CRP value and in patients who received antibiotic therapy for more than six weeks (p < 0.05). Unfavorable outcomes were noted in patients with high CRP, postoperative spondylodiscitis, and recurrent spondylodiscitis (p < 0.05). Application of antibiotic therapy for more than six weeks and normalized CRP showed a correlation with favorable outcomes, whereas concomitant infections showed a correlation with unfavorable outcomes. A detailed screening for concomitant infectious diseases is recommended.
Collapse
Affiliation(s)
- Mirza Pojskić
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (B.C.); (V.S.); (B.V.); (C.N.); (B.S.)
- Correspondence: ; Tel.: +49-64215869848
| | - Barbara Carl
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (B.C.); (V.S.); (B.V.); (C.N.); (B.S.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany
- Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, 65199 Wiesbaden, Germany
| | - Vincent Schmöckel
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (B.C.); (V.S.); (B.V.); (C.N.); (B.S.)
| | - Benjamin Völlger
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (B.C.); (V.S.); (B.V.); (C.N.); (B.S.)
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (B.C.); (V.S.); (B.V.); (C.N.); (B.S.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany
| | - Benjamin Saβ
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (B.C.); (V.S.); (B.V.); (C.N.); (B.S.)
| |
Collapse
|
14
|
Purea T, Vettivel J, Hunt L, Passias PG, Baker JF. Radiographic Features Associated With Increased Surgical Invasiveness in Pyogenic Vertebral Column Osteomyelitis. Global Spine J 2021; 11:881-888. [PMID: 32677516 PMCID: PMC8258830 DOI: 10.1177/2192568220928965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
STUDY DESIGN Single center retrospective cohort study. OBJECTIVES Assess the association between well-known radiographic features for spinal instability from the Spinal Instability in Neoplasia Score (SINS) and surgical invasiveness in treating vertebral column osteomyelitis (VCO). This will potentially help surgeons in surgical planning and aid in developing a pathology specific score. METHODS Patients with VCO were identified from hospital coding. On preoperative computed tomography radiographic features, including spinal alignment, vertebral body collapse, location, type of bone lesion, and posterolateral involvement were assessed and scored 0 (stable) to 15 (highly unstable). Surgical invasiveness was graded as 0 = no surgery, 1 = decompression alone, 2 = shortening or posterior stabilization, or 3 = anterior column reconstruction. RESULTS A total of 41 patients were included. The mean age of the cohort was 63.3 years (SD 12.0) with male comprising 78%. The mean total radiographic score for the nonsurgical group was 6.39 (3.14) and for the surgical group 10.38 (3.06), P < .001. Spinal alignment, vertebral body collapse, type of bone lesion, and posterolateral involvement correlated with surgical invasiveness (all Ps < .05). Subgroup comparison following analysis of variance showed that only spinal alignment was significantly different between groups 2 and 3. CONCLUSIONS Our findings show correlation of the radiographic components of the SINS with surgical invasiveness in management of pyogenic VCO-these findings should aid development of an "instability score" in pyogenic VCO. While most radiographic features assessed correlated with surgical invasiveness spinal alignment appears to be the key feature in determining the need for more invasive surgery.
Collapse
Affiliation(s)
| | | | - Lyn Hunt
- Department of Computing and Mathematical Sciences, University of Waikato, Hamilton, New Zealand
| | | | - Joseph F. Baker
- Waikato Hospital, Hamilton, New Zealand,University of Auckland, Auckland, New Zealand,Joseph F. Baker, Department of Orthopaedic Surgery, Waikato Hospital, Pembroke Street, Hamilton, New Zealand.
| |
Collapse
|
15
|
Zanon IDB, Tsai VL, Ribeiro TC, Astur N, Mendonça RGMD, Gotfryd AO, Salles MJC, Caffaro MFS, Klautau GB, Meves R. THE PROFILE OF POTT’S DISEASE IN A SOUTH AMERICAN REFERENCE SERVICE. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212002234844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: Tuberculosis (TB) represents one of the top ten causes of death in the world. Its insidious onset and nonspecific symptoms usually result in delayed diagnosis. The objective is to evaluate the characteristics of patients with tuberculous spondylodiscitis in follow-up at a South American reference hospital. Method: Retrospective evaluation of the medical records of patients of both sexes and between 0 and 80 years of age diagnosed with tuberculosis of the spine between 2009 and 2018. The variables were analyzed based on groups: epidemiological, clinical, laboratorial, microbiological, imaging tests and treatment. Results: Total of 26 cases, about 80.8% male, mean age 41.6 ± 22.46 years. Axial pain was the most prevalent symptom (84.6%), the VAS score was 6.85 ± 2.87. The mean time between symptom onset and diagnosis was 23.8 ± 24.1 weeks (4-96). The most affected region was the thoracic spine (50% of the cases). Most participants (61.4%) had no change in neurological function (Frankel D and E) at the beginning of treatment and after 6 months, and 84.5% improved. During treatment 34.6% required surgery and the main indication was isolated neurological deficit (55.5%). The most frequently performed procedure was decompression and arthrodesis (55.5%). The average time to cure was 12.0 ± 8.8 months (8-48). Conclusion: Disease with insidious onset, nonspecific symptoms, high frequency of negative microbiological tests in cases with the disease. A small number of the cases required surgical treatment and most of them achieved good neurological recovery. Level of evidence IV; Case series.
Collapse
|
16
|
Kim NJ. Microbiologic Diagnosis of Pyogenic Spondylitis. Infect Chemother 2021; 53:238-246. [PMID: 34216118 PMCID: PMC8258299 DOI: 10.3947/ic.2021.0054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022] Open
Abstract
Pyogenic spondylitis requires long-term antibiotics treatment and identification of the etiologic microorganism is essential. The first test in the microbiologic diagnosis of pyogenic spondylitis is a blood culture. Any microorganisms that grow in blood culture are highly likely to be the etiological microorganisms of pyogenic spondylitis. If the microbial etiology cannot be defined by the blood culture, a needle biopsy is performed on the inflamed tissues. Here, it is recommended that paraspinal tissues, rather than spinal tissues, are collected to increase the positive rate in tissue culture. If the microbial etiology cannot be defined by the first needle biopsy, another needle biopsy may be performed. The collected tissue sample is used in culture tests on bacteria and mycobacteria as well as pathological tests. If tuberculous spondylitis is suspected, polymerase chain reaction is carried out to detect Mycobacterium tuberculosis. In the case that the etiological microorganisms cannot be identified, the data of the patient regarding age, sex, vertebrae involved, history of spinal surgery or procedure, previous or concurrent urinary tract or intra-abdominal infection are analyzed. Based on this the most probable microbial etiology is determined to select the antibiotics to be used in the empiric treatment.
Collapse
Affiliation(s)
- Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
17
|
Gao X, Wan S, Lv J, Cheng W, Zhang Y. Comparison anterior minimally invasive oblique retroperitoneal approach and posterior transpedicular approach for debridement fusion in patients with lumbar vertebral osteomyelitis: A randomized controlled trial protocol. Medicine (Baltimore) 2020; 99:e22990. [PMID: 33126375 PMCID: PMC7598824 DOI: 10.1097/md.0000000000022990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pyogenic osteomyelitis of the spine usually occurs in patients over 55 years old with acute osteomyelitis. Surgical treatment and fixation can relieve pain, enhance spinal balance and nerve function, so that patients can walk as soon as possible. Different outcomes of surgical methods include anterior minimally invasive oblique retroperitoneal approach (ORA) and posterior transpedicular approach (PTA). While, there is no consensus on the best treatment for PVO. The goal of the protocol is to compare the clinical consequences between PTA and ORA for treating PVO. METHOD The experiment is a single-center randomized clinical research. This experiment was admitted by the Ethics Committee of the People's Hospital of Dayi County (Approval number: 1002-084). In all, 50 patients with lumbar vertebral osteomyelitis (LVO) who prepares surgical treatment will be included in the study. We contain adult patients (aged over 18 years) who accept debridement and spinal stabilization with LVO. Cases are removed if there is previous hardware placement, cases who are not confirmed by microbiology, or severe renal and liver dysfunction. The primary outcomes are intraoperative blood loss, operative time, hospital stay, primary failure and recurrence, and bone fusion. The secondary outcomes are postoperative pain score and physical recovery. SPSS Sample Power version 3.0 (IBM, Armonk, NY, USA) is used for data analysis. RESULTS Table 1 will show the outcomes in both groups. CONCLUSION This protocol may offer a reliable basis for the effectiveness of the two approaches in the treatment of PVO. TRIAL REGISTRATION NUMBER researchregistry6046.
Collapse
Affiliation(s)
| | - Shu Wan
- Department of Stomatology, The People's Hospital of Dayi County, Chengdu, Sichuan, China
| | - Jie Lv
- Department of Orthopedics
| | | | | |
Collapse
|
18
|
Jacquier H, Fihman V, Amarsy R, Vicaut E, Bousson V, Cambau E, Crémieux AC, Delcey V, Hannouche D, Kaci R, Laredo JD, Meunier F, Nizard R, Ottaviani S, Parlier C, Richette P, Sellier P, Zadegan F, Lioté F, Berçot B. Benefits of Polymerase Chain Reaction Combined With Culture for the Diagnosis of Bone and Joint Infections: A Prospective Test Performance Study. Open Forum Infect Dis 2019; 6:ofz511. [PMID: 31909081 PMCID: PMC6935679 DOI: 10.1093/ofid/ofz511] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 11/30/2019] [Indexed: 12/28/2022] Open
Abstract
Background The microbiological diagnosis of bone and joint infections (BJI) currently relies on cultures, and the relevance of molecular methods is still debated. The aim of this study was to determine whether polymerase chain reaction (PCR) could improve the etiological diagnosis of BJI. Methods A prospective study was conducted during a 4-year period at Lariboisiere University Hospital (Paris, France), including patients with suspicion of infectious spondylodiscitis, septic arthritis, prosthetic joint infections, and respective noninfected groups. Clinical and radiological data were collected at inclusion and during follow-up. All samples were analyzed by conventional cultures and 16S ribosomal deoxyribonucleic acid (rDNA) gene (16S-PCR). Specific cultures and PCR targeting Mycobacterium tuberculosis were also performed for spondylodiscitis samples. Case records were subsequently analyzed by an independent expert committee to confirm or invalidate the suspicion of infection and definitively classify the patients in a case or control group. The sensitivity of the combination of culture and PCR was compared with culture alone. Results After expert committee analysis, 105 cases of BJI cases and 111 control patients were analyzed. The most common pathogens of BJI were staphylococci (30%), M tuberculosis (19%), and streptococci (14%). Adding PCR enhanced the sensitivity compared with culture alone (1) for the diagnosis of M tuberculosis spondylodiscitis (64.4% vs 42.2%; P < .01) and (2) for nonstaphylococci BJI (81.6% vs 71.3%; P < .01). It is interesting to note that 16S-PCR could detect BJI due to uncommon bacteria such as Mycoplasma and fastidious bacteria. Conclusions Our study showed the benefit of 16S-PCR and PCR targeting M tuberculosis as add-on tests in cases of suspected BJI.
Collapse
Affiliation(s)
- Hervé Jacquier
- Laboratory of Bacteriology, Infectious Agents Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,IAME UMR 1137, INSERM and Université de Paris, Paris, France
| | - Vincent Fihman
- Bacteriology and Infection Control Unit, Department of Microbiology, University Hospital Henri Mondor, APHP, Creteil, France.,EA Dynamyc, Université Paris Est Créteil-Ecole Vétérinaire de Maison Alfort, Créteil, France
| | - Rishma Amarsy
- Infection Control Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Eric Vicaut
- Unit of Clinical Research, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Valérie Bousson
- Unit of Radiology, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Emmanuelle Cambau
- Laboratory of Bacteriology, Infectious Agents Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,IAME UMR 1137, INSERM and Université de Paris, Paris, France
| | - Anne-Claude Crémieux
- Department of Infectious Diseases, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Véronique Delcey
- Department of Medecine, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Didier Hannouche
- Department of Orthopaedic Surgery, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Rachid Kaci
- Department of Pathological Anatomy and Cytology, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Jean-Denis Laredo
- Unit of Radiology, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Fabienne Meunier
- Laboratory of Bacteriology, Infectious Agents Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Rémy Nizard
- Department of Orthopaedic Surgery, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Sébastien Ottaviani
- Federation of Rheumatology, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Caroline Parlier
- Unit of Clinical Research, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Pascal Richette
- Department of Pathological Anatomy and Cytology, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Pierre Sellier
- Department of Medecine, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Fréderic Zadegan
- Department of Orthopaedic Surgery, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Fréderic Lioté
- Federation of Rheumatology, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, APHP, Paris, France
| | - Béatrice Berçot
- Laboratory of Bacteriology, Infectious Agents Department, Saint Louis-Lariboisiere-Fernand Widal Hospital Group, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,IAME UMR 1137, INSERM and Université de Paris, Paris, France
| | | |
Collapse
|
19
|
Scharrenberg JS, Yagdiran A, Brinkmann J, Brune M, Siewe J, Jung N, Mahabir E. The diagnostic value of soluble urokinase-type plasminogen activator receptor (suPAR) for the discrimination of vertebral osteomyelitis and degenerative diseases of the spine. J Orthop Surg Res 2019; 14:367. [PMID: 31727136 PMCID: PMC6854784 DOI: 10.1186/s13018-019-1420-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/15/2019] [Indexed: 12/18/2022] Open
Abstract
Background There is still a challenge in discriminating between vertebral osteomyelitis and degenerative diseases of the spine. To this end, we determined the suitability of soluble urokinase-type plasminogen activator receptor (suPAR) and compared the diagnostic potential of suPAR to CRP. Methods Patients underwent surgical stabilization of the lumbar and/or thoracic spine with removal of one or more affected intervertebral discs, as therapy for vertebral osteomyelitis (n = 16) or for erosive osteochondrosis (control group, n = 20). In this prospective study, we evaluated the suPAR and CRP levels before (pre-OP) and after surgery (post-OP) on days 3–5, 6–11, 40–56, and 63–142. Results The suPAR levels in vertebral osteomyelitis patients were significantly higher than those from controls pre-OP, 3–5 days post-OP, and 6–11 days post-OP. Significantly higher CRP levels were observed in the vertebral osteomyelitis group than in the controls pre-OP and 6–11 days post-OP. Levels of suPAR and CRP correlated positively in all patients in the pre-OP period: r = 0.63 (95% CI: 0.37–0.79), p < 0.0001. The values for the area under the receiver operating characteristics curve (AUC) for pre-OP and the overall model post-OP were 0.88 (95% CI: 0.76–1.00) and 0.84 (95% CI: 0.71–0.97) for suPAR, 0.93 (95% CI: 0.85–1.00) and 0.77 (95% CI: 0.62–0.93) for CRP, and 0.98 (95% CI: 0.96–1.00) and 0.91 (95% CI: 0.82–1.00) for the combination of suPAR and CRP. The AUC for suPAR pre-OP revealed an optimum cut-off value, sensitivity, specificity, NPV, and PPV of 2.96 ng/mL, 0.69, 1.00, 0.80, and 1.00, respectively. For CRP, these values were 11.58 mg/L, 0.88, 0.90, 0.90, and 0.88, respectively. Conclusion The present results show that CRP is more sensitive than suPAR whereas suPAR is more specific than CRP. Moreso, our study demonstrated that improvement in the diagnostic power for discrimination of vertebral osteomyelitis and degenerative diseases of the spine can be achieved by a combination of both suPAR and CRP. Trial registration ClinicalTrials.gov, NCT02554227, posted Sept. 18, 2015, and updated Aug. 13, 2019
Collapse
Affiliation(s)
- Jan Simon Scharrenberg
- Comparative Medicine, Center for Molecular Medicine, University of Cologne, Robert-Koch-Straße 21, 50931, Cologne, Germany
| | - Ayla Yagdiran
- Department of Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Julia Brinkmann
- Comparative Medicine, Center for Molecular Medicine, University of Cologne, Robert-Koch-Straße 21, 50931, Cologne, Germany
| | - Maik Brune
- Department of Medicine I and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Siewe
- Faculty of Medicine, University Hospital, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
| | - Esther Mahabir
- Comparative Medicine, Center for Molecular Medicine, University of Cologne, Robert-Koch-Straße 21, 50931, Cologne, Germany.
| |
Collapse
|
20
|
Joint EANM/ESNR and ESCMID-endorsed consensus document for the diagnosis of spine infection (spondylodiscitis) in adults. Eur J Nucl Med Mol Imaging 2019; 46:2464-2487. [PMID: 31399800 DOI: 10.1007/s00259-019-04393-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/04/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Diagnosis of spondylodiscitis (SD) may be challenging due to the nonspecific clinical and laboratory findings and the need to perform various diagnostic tests including serologic, imaging, and microbiological examinations. Homogeneous management of SD diagnosis through international, multidisciplinary guidance would improve the sensitivity of diagnosis and lead to better patient outcome. METHODS An expert specialist team, comprising nuclear medicine physicians appointed by the European Association of Nuclear Medicine (EANM), neuroradiologists appointed by the European Society of Neuroradiology (ESNR), and infectious diseases specialists appointed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), reviewed the literature from January 2006 to December 2015 and proposed 20 consensus statements in answer to clinical questions regarding SD diagnosis. The statements were graded by level of evidence level according to the 2011 Oxford Centre for Evidence-based Medicine criteria and included in this consensus document for the diagnosis of SD in adults. The consensus statements are the result of literature review according to PICO (P:population/patients, I:intervention/indicator, C:comparator/control, O:outcome) criteria. Evidence-based recommendations on the management of adult patients with SD, with particular attention to radiologic and nuclear medicine diagnosis, were proposed after a systematic review of the literature in the areas of nuclear medicine, radiology, infectious diseases, and microbiology. RESULTS A diagnostic flow chart was developed based on the 20 consensus statements, scored by level of evidence according to the Oxford Centre for Evidence-based Medicine criteria. CONCLUSIONS This consensus document was developed with a final diagnostic flow chart for SD diagnosis as an aid for professionals in many fields, especially nuclear medicine physicians, radiologists, and orthopaedic and infectious diseases specialists.
Collapse
|
21
|
Saeed K, Esposito S, Ascione T, Bassetti M, Bonnet E, Carnelutti A, Chan M, Lye DC, Cortes N, Dryden M, Fernando S, Gottlieb T, Gould I, Hijazi K, Madonia S, Pagliano P, Pottinger PS, Segreti J, Spera AM. Hot topics on vertebral osteomyelitis from the International Society of Antimicrobial Chemotherapy. Int J Antimicrob Agents 2019; 54:125-133. [PMID: 31202920 DOI: 10.1016/j.ijantimicag.2019.06.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Kordo Saeed
- Hampshire Hospitals NHS Foundation Trust, UK, and University of Southampton Medical School, UK.
| | - Silvano Esposito
- Department of Infectious Diseases, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Tiziana Ascione
- Department of Infectious Diseases, AORN dei Colli, Naples, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Eric Bonnet
- Department of Infectious Diseases, Joseph Ducuing Hospital et Clinique Pasteur, Toulouse, France
| | - Alessia Carnelutti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Monica Chan
- Department of Infectious Diseases, Tan Tock Seng Hospital, National Centre for Infectious Diseases, Singapore
| | - David Chien Lye
- Tan Tock Seng Hospital, National Centre for Infectious Diseases, Yong Loo Lin School of Medicine, and Lee Kong Chian School of Medicine, Singapore
| | - Nicholas Cortes
- Hampshire Hospitals NHS Foundation Trust, UK, and University of Southampton Medical School, UK; Gibraltar Health Authority, Gibraltar, UK
| | - Matthew Dryden
- Hampshire Hospitals NHS Foundation Trust, UK, and University of Southampton Medical School, UK
| | - Shelanah Fernando
- Department of Microbiology and Infectious Diseases, Concord Hospital, Concord, NSW, Australia
| | - Thomas Gottlieb
- Department of Microbiology and Infectious Diseases, Concord Hospital, Concord, NSW, Australia; Department of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Ian Gould
- Department of Medical Microbiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Karolin Hijazi
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Simona Madonia
- Department of Infectious Diseases, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | - Paul S Pottinger
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - John Segreti
- Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Anna Maria Spera
- Department of Infectious Diseases, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | |
Collapse
|
22
|
Okay G, Akkoyunlu Y, Bolukcu S, Durdu B, Hakyemez IN, Koc MM. Analysis of infectious spondylodiscitis: 7-years data. Pak J Med Sci 2018; 34:1445-1451. [PMID: 30559801 PMCID: PMC6290200 DOI: 10.12669/pjms.346.15717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: Infectious spondylodiscitis (SD) is an infectious disease that is rare and difficult to diagnose due to its non-specific clinical features. In this study, we aimed to describe the clinical and diagnostic features of infectious spondylodiscitis. Methods: All patients who were diagnosed with SD at our hospital during a 7-year period from January 1, 2011 through December 31, 2017 were included in the study. Spondylodiscitis is divided into the following three types: pyogenic, tuberculous, and brucellar. Clinical and laboratory data were collected retrospectively from the medical records of the patients. Results: Of the 118 patients, 66 (55.9%) were female, 81 (68.6%) had pyogenic SD (PSD), 21 (17.8%) had tuberculous SD (TSD), and 16 (13.6%) had brucellar SD (BSD). The mean age was 59.3 ± 14.6 years. Leucocytosis was significantly higher in patients with PSD (p=0.01) than in patients with other types of SD. Thoracic involvement (47.6%) was significantly higher in patients with TSD (p=0.005) than in other patients. Sacral involvement (12.5%) was significantly higher in patients with BSD (p=0.01) than in other patients. Paravertebral abscess formation (42.8%) occurred most frequently in patients with TSD. Microbiologic agents were defined in 50% (18/36) of the surgical specimens and in 12.5% of the fine needle aspiration biopsy (FNAB) specimens. Staphylococcus aureus was the most common microbiological agent in patients with PSD. Spinal surgery was defined as a risk factor for PSD (p = 0.0001). Binary logistic regression analysis revealed that female gender, thoracic involvement and night sweats were the predictive markers for TSD (OR 4.5 [95% CI 1.3-15.3] and OR 5 [95% CI 1.7-14.6]). Conclusion: PSD is the most frequent form of SD. Leucocytosis is most common in patients with PSD. Thoracic involvement and paraspinal abscess were prominent in patients with TSD. Sacral involvement was most common in patients with BSD. Thoracic involvement, female gender and night sweats were the predictive markers for TSD. The microbiological culture positivity rate was higher in surgical specimens compared to FNAB specimens. The need for surgical treatment was most common in patients with TSD.
Collapse
Affiliation(s)
- Gulay Okay
- Gulay Okay, MD. Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yasemin Akkoyunlu
- Yasemin Akkoyunlu, Associate Professor. Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Sibel Bolukcu
- Sibel Bolukcu, MD Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Bulent Durdu
- Bulent Durdu, Assistant Professor. Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ismail Necati Hakyemez
- Ismail Necati Hakyemez, Associate Professor. Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Meliha Meric Koc
- Prof. Meliha Meric Koc, Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
23
|
Abstract
Bone and joint infections are potentially limb-threatening or even life-threatening diseases. Emergency physicians must consider infection when evaluating musculoskeletal complaints, as misdiagnosis can have significant consequences. Patients with bone and joint infections can have heterogeneous presentations with nonspecific signs and symptoms. Staphylococcus aureus is the most commonly implicated microorganism. Although diagnosis may be suggested by physical examination, laboratory testing, and imaging, tissue sampling for Gram stain and microbiologic culture is preferable, as pathogen identification and susceptibility testing help optimize long-term antibiotic therapy. A combination of medical and surgical interventions is often necessary to effectively manage these challenging infections.
Collapse
Affiliation(s)
- Daniel C Kolinsky
- Department of Emergency Medicine, Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119, USA
| | - Stephen Y Liang
- Division of Emergency Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8072, St Louis, MO 63110, USA; Division of Infectious Diseases, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St Louis, MO 63110, USA.
| |
Collapse
|
24
|
Herren C, Jung N, Pishnamaz M, Breuninger M, Siewe J, Sobottke R. Spondylodiscitis: Diagnosis and Treatment Options. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:875-882. [PMID: 29321098 PMCID: PMC5769318 DOI: 10.3238/arztebl.2017.0875] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 05/19/2017] [Accepted: 10/16/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND A recent population-based study from Denmark showed that the incidence of spondylodiscitis rose from 2.2 to 5.8 per 100 000 persons per year over the period 1995-2008; the age-standardized incidence in Germany has been estimated at 30 per 250 000 per year on the basis of data from the Federal Statistical Office (2015). The early diagnosis and treatment of this condition are essential to give the patient the best chance of a good outcome, but these are often delayed because it tends to present with nonspecific manifestations, and fever is often absent. METHODS This article is based on a systematic search of Medline and the Cochrane Library for the period January 2009 to March 2017. Of the 788 articles identified, 30 publications were considered. RESULTS The goals of treatment for spondylodiscitis are to eliminate infection, restore functionality of the spine, and relieve pain. Magnetic resonance imaging (MRI) remains the gold standard for the radiological demonstration of this condition, with 92% sensitivity and 96% specificity. It also enables visualization of the spatial extent of the infection and of abscess formation (if present). The most common bacterial cause of spondylodiscitis in Europe is Staphylococcus aureus, but tuberculous spondylodiscitis is the most common type worldwide. Antibiotic therapy is a pillar of treatment for spondylodiscitis and should be a part of the treatment in all cases. Neurologic deficits, sepsis, an intraspinal empyema, the failure of conservative treatment, and spinal instability are all indications for surgical treatment. CONCLUSION The quality of life of patients who have been appropriately treated for spondylodiscitis has been found to be highly satisfactory in general, although back pain often persists. The risk of recurrence increases in the presence of accompanying illnesses such as diabetes mellitus, renal failure, or undrained epidural abscesses.
Collapse
Affiliation(s)
- Christian Herren
- Department for Trauma and Reconstructive Surgery, University Hospital RWTH Aachen
| | - Norma Jung
- Department I for Internal Medicine, University Hospital Cologne
| | - Miguel Pishnamaz
- Department for Trauma and Reconstructive Surgery, University Hospital RWTH Aachen
| | | | - Jan Siewe
- Center of Orthopedic and Trauma Surgery, University Hospital Cologne
| | - Rolf Sobottke
- Center of Orthopedic and Trauma Surgery, University Hospital Cologne
- Center for Orthopaedics and Trauma Surgery, Rhein-Maas Klinikum GmbH, Würselen
| |
Collapse
|
25
|
Abstract
Septic arthritis and spondylodiscitis are relatively rare but severe diseases with increasing incidence. Septic arthritis is an emergency situation with high morbidity (40 %) and fatality rates (11 %). The infection occurs via a hematogenous route by direct inoculation or per continuitatem. Patients with pre-existing destructive joint diseases or under immunosuppressive treatment are particularly at risk. It is mandatory to sample synovial fluid for isolation of the relevant pathogen and quantification of leucocytes before starting antibiotic therapy. In order to preserve the joint, early evacuation of the infected synovial space is necessary. Spondylodiscitis is characterized by infection of the vertebra and neighboring discs mainly via a hematogenous route. Immunosuppressed and older patients are primarily at risk of infection. Back pain represents the main symptom but due to its unspecific character and the frequent absence of fever, diagnosis is often delayed. In Europe Staphylococcus aureus is the most prevalent pathogen, whereas tuberculosis is the most frequent causal agent worldwide. Magnetic resonance imaging (MRI) respresents the method of choice for the radiological diagnostics. In stable patients isolation of the pathogen should be achieved before starting antimicrobial therapy (e.g. blood cultures or tissue samples by computed tomography guided puncture or biopsy). The recommended duration of pathogen-specific antibiotic therapy for native spondylodiscitis is normally 6 weeks.
Collapse
Affiliation(s)
- N Jung
- Klinik 1 für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50935, Köln, Deutschland.
| | - S Vossen
- Plastische, Ästhetische und Handchirurgie, Franziskushospital Aachen, 52074, Aachen, Deutschland
| |
Collapse
|
26
|
Epidemiologic and Demographic Attributes of Primary Spondylodiscitis in a Middle Eastern Population Sample. World Neurosurg 2016; 95:31-39. [DOI: 10.1016/j.wneu.2016.07.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/22/2016] [Accepted: 07/23/2016] [Indexed: 12/17/2022]
|
27
|
Abstract
INTRODUCTION The incidence of vertebral osteomyelitis is increasing, attributed to an ageing population with inherent co-morbidities and improved case ascertainment. SOURCES OF DATA References were retrieved from the PubMed database using the terms 'vertebral osteomyelitis' and 'spondylodiscitis' between January 1, 2009 and April 30, 2014 published in English as checked in May 2014 (>1000 abstracts checked). AREAS OF AGREEMENT Blood cultures and whole spine imaging with magnetic resonance imaging are essential investigations. Thorough debridement is the mainstay of surgical management, although placing metalwork in active infection is becoming increasingly common. AREAS OF CONTROVERSY The extent of pursuing spinal biopsies to determine aetiology, antimicrobial choices and duration, monitoring the response to treatment, and surgical techniques and timing all vary widely in clinical practice with heterogeneous studies limiting comparisons. Surgery, rather than conservative approaches, is being proposed as the default management choice, because it can, in carefully selected patients, offer faster reduction in pain scores and improved quality of life. AREAS TIMELY FOR DEVELOPING RESEARCH Further studies are needed to define the most effective technique for spinal biopsies to maximize determining aetiology. High-quality trials are required to provide an evidence base for both the medical and surgical management of vertebral osteomyelitis, including challenging medical management as the default option.
Collapse
Affiliation(s)
- Emma K Nickerson
- Department of Infectious Diseases, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Rohitashwa Sinha
- Department of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| |
Collapse
|
28
|
Batirel A, Erdem H, Sengoz G, Pehlivanoglu F, Ramosaco E, Gülsün S, Tekin R, Mete B, Balkan II, Sevgi DY, Giannitsioti E, Fragou A, Kaya S, Cetin B, Oktenoglu T, Celik AD, Karaca B, Horasan ES, Ulug M, Senbayrak S, Kaya S, Arslanalp E, Hasbun R, Ates-Guler S, Willke A, Senol S, Inan D, Güclü E, Ertem GT, Koc MM, Tasbakan M, Ocal G, Kocagoz S, Kusoglu H, Güven T, Baran AI, Dede B, Karadag FY, Yilmaz H, Aslan G, Al-Gallad DA, Cesur S, El-Sokkary R, Sirmatel F, Savasci U, Karaahmetoglu G, Vahaboglu H. The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study. Clin Microbiol Infect 2015; 21:1008.e9-1008.e18. [PMID: 26232534 DOI: 10.1016/j.cmi.2015.07.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 01/09/2023]
Abstract
We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis (ST), also known as Pott disease. A total of 314 patients with ST from 35 centres in Turkey, Egypt, Albania and Greece were included. Median duration from initial symptoms to the time of diagnosis was 78 days. The most common complications presented before diagnosis were abscesses (69%), neurologic deficits (40%), spinal instability (21%) and spinal deformity (16%). Lumbar (56%), thoracic (49%) and thoracolumbar (13%) vertebrae were the most commonly involved sites of infection. Although 51% of the patients had multiple levels of vertebral involvement, 8% had noncontiguous involvement of multiple vertebral bodies. The causative agent was identified in 41% of cases. Histopathologic examination was performed in 200 patients (64%), and 74% were consistent with tuberculosis. Medical treatment alone was implemented in 103 patients (33%), while 211 patients (67%) underwent diagnostic and/or therapeutic surgical intervention. Ten percent of the patients required more than one surgical intervention. Mortality occurred in 7 patients (2%), and 77 (25%) developed sequelae. The distribution of the posttreatment sequelae were as follows: 11% kyphosis, 6% Gibbus deformity, 5% scoliosis, 5% paraparesis, 5% paraplegia and 4% loss of sensation. Older age, presence of neurologic deficit and spinal deformity were predictors of unfavourable outcome. ST results in significant morbidity as a result of its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. ST should be considered in the differential diagnosis of patients with vertebral osteomyelitis, especially in tuberculosis-endemic regions. Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae.
Collapse
Affiliation(s)
- A Batirel
- Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - H Erdem
- Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
| | - G Sengoz
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Pehlivanoglu
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - E Ramosaco
- Infectious Diseases Hospital, University Hospital Center "Mother Teresa", Tirana, Albania
| | - S Gülsün
- Diyarbakir Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - R Tekin
- Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - B Mete
- Istanbul University Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - I I Balkan
- Istanbul University Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - D Y Sevgi
- Sisli Etfal Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - E Giannitsioti
- Department of Internal Medicine, Athens University Medical School, Attikon University General Hospital, Athens, Greece
| | - A Fragou
- Department of Internal Medicine, Athens University Medical School, Attikon University General Hospital, Athens, Greece
| | - S Kaya
- Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
| | - B Cetin
- Koc University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - T Oktenoglu
- Koc University School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - A D Celik
- Trakya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Edirne, Turkey
| | - B Karaca
- Izmir Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - E S Horasan
- Mersin University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey
| | - M Ulug
- Private Umit Hospital, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey
| | - S Senbayrak
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - S Kaya
- Diyarbakir Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - E Arslanalp
- Kocaeli University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey
| | - R Hasbun
- The University of Texas Health Science Center at Houston, Medical School, Department of Infectious Diseases, Turkey
| | - S Ates-Guler
- Sutcu Imam University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kahramanmaras, Turkey
| | - A Willke
- Kocaeli University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey
| | - S Senol
- Celal Bayar University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Manisa, Turkey
| | - D Inan
- Akdeniz University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey
| | - E Güclü
- Sakarya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya, Turkey
| | - G T Ertem
- Ankara Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - M M Koc
- Kocaeli University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey
| | - M Tasbakan
- Ege University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - G Ocal
- Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - S Kocagoz
- Acibadem University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Kusoglu
- Acibadem University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - T Güven
- Ankara Atatürk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - A I Baran
- Yuzuncuyil University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Van, Turkey
| | - B Dede
- Umraniye Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Y Karadag
- Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Yilmaz
- Ondokuz Mayis University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - G Aslan
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | | | - S Cesur
- Ankara Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - R El-Sokkary
- Medical Microbiology and Immunology, Infection Control Unit, Zagazig University, Zagazig, Egypt
| | - F Sirmatel
- Izzet Baysal University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey
| | - U Savasci
- Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - G Karaahmetoglu
- GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Vahaboglu
- Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| |
Collapse
|
29
|
Talia AJ, Wong ML, Lau HC, Kaye AH. Safety of instrumentation and fusion at the time of surgical debridement for spinal infection. J Clin Neurosci 2015; 22:1111-6. [PMID: 25911501 DOI: 10.1016/j.jocn.2014.12.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/22/2014] [Accepted: 12/26/2014] [Indexed: 12/29/2022]
Abstract
The present study aims to assess the results of single-stage instrumentation and fusion at the time of surgical debridement of spinal infections; vertebral osteomyelitis or epidural abscess. Nine patients with spinal infection were treated with instrumentation and fusion after radical debridement in a single-stage operation. Predisposing factors and comorbidities, pain, American Spinal Injury Association motor scores, primary pathologies, microbiology and perioperative markers were recorded. Seven patients with pyogenic and two with tuberculous spinal infection were encountered; the most common pathogen was Staphylococcus aureus. Five patients were predisposed to infection because of diabetes mellitus. Duration of antibiotic therapy lasted up to 12 months. Six patients had thoracic infection, two lumbar and one cervical. No post-operative complications were encountered. There was a significant reduction in pain scores compared to pre-operatively. All patients with neurological deficits improved post-operatively. Despite introduction of hardware, no patients had a recurrence of their infection in the 12 month follow up period. Single-stage debridement and instrumentation appeared to be a safe and effective method of managing spinal infections. The combination of debridement and fusion has the dual benefit of removing a focus of infection and stabilising the spine. The current series confirms that placing titanium cages into an infected space is safe in a majority of patients. Stabilisation and correction of spinal deformity reduces pain, aids neurologic recovery and improves quality of life. The small patient population and retrospective nature limit the present study.
Collapse
Affiliation(s)
- Adrian J Talia
- Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia.
| | - Michael L Wong
- Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia
| | - Hui C Lau
- Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia
| | - Andrew H Kaye
- Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia
| |
Collapse
|
30
|
Characteristics of vertebral osteomyelitis after liver transplantation. Clin Microbiol Infect 2015; 21:573-7. [PMID: 25726040 DOI: 10.1016/j.cmi.2015.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/17/2014] [Accepted: 01/19/2015] [Indexed: 11/22/2022]
Abstract
We performed a retrospective single-centre 1:3 case-control study to investigate the characteristics of vertebral osteomyelitis (VO) occurring in orthotopic liver transplant (OLT) recipients between 2000 and 2012. Nine cases were identified in 752 OLT recipients (1.2%), with a median time from OLT to VO of 12 weeks. In comparison with 27 VO not occurring in OLT patients (controls), VO occurring in OLT recipients was characterized by decreased levels of inflammation biomarkers (average C-reactive protein 65.1 mg·L(-1) vs. 167 mg·L(-1), p 0.02; average white blood cell count 4.8 × 10(9)·L(-1) vs. 12.9 × 10(9)·L(-1), p < 0.001), higher rate of fungal infections (3/9 vs. 0/27, p 0.01), lower rate of bacterial infections (3/9 vs. 25/27, p 0.001) and decreased proportion of positive blood cultures (1/9 vs. 16/27, p 0.02) despite a trend towards higher rate of multifocal infection. Microbiologic outcomes were similar between the two groups. Overall, VO in OLT patients was more difficult to diagnose as a result of altered inflammation response and specific microbial epidemiology of causal microorganisms.
Collapse
|
31
|
Pupaibool J, Vasoo S, Erwin PJ, Murad MH, Berbari EF. The utility of image-guided percutaneous needle aspiration biopsy for the diagnosis of spontaneous vertebral osteomyelitis: a systematic review and meta-analysis. Spine J 2015; 15:122-31. [PMID: 25058561 DOI: 10.1016/j.spinee.2014.07.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 05/06/2014] [Accepted: 07/09/2014] [Indexed: 02/09/2023]
Abstract
BACKGROUND CONTEXT Spontaneous vertebral osteomyelitis (SVOM) is mostly acquired via hematogenous seeding. Diagnosis of SVOM is often delayed because of the insidious nature and rarity of this disease. The microbiological yield of image-guided needle biopsy varies between 36% and 91%. The utility and accuracy of this procedure have not been systematically reviewed. PURPOSE To systematically review and assess the diagnostic accuracy of image-guided spinal biopsy for SVOM in adults when compared with combined reference standards. STUDY DESIGN A systematic review and meta-analysis. SAMPLE Seven retrospective studies involving 482 patients with clinical and/or radiologic suspicion of SVOM who underwent image-guided spinal biopsy were included. OUTCOME MEASURES The primary outcome measure was diagnostic odds ratio (DOR). Other outcomes included likelihood ratio of a positive test (LRP), likelihood ratio of a negative test (LRN), sensitivity, and specificity. METHODS We searched in six medical databases through September 1, 2013 for studies evaluating the performance of image-guided spinal biopsy for SVOM with no limits on language or publication date. Combined reference standards, which included histopathologic findings consistent with vertebral osteomyelitis, identifications of pathogens from open surgery and/or blood cultures, and/or evidence of clinical and radiologic improvement after empiric antimicrobial therapy, were used for comparison. The random-effect model was used for meta-analysis. Two reviewers independently selected the studies. RESULTS Three hundred fifty-eight potentially relevant studies were identified. Seven studies were included in our analysis. Two studies that used only single reference standard were excluded in the sensitivity analysis, and five studies involving 352 patients were pooled. Image-guided spinal biopsy had a DOR of 45.50 (95% confidence interval [CI], 13.66-151.56), an LRP of 16.76 (95% CI, 5.51-50.95), an LRN of 0.39 (95% CI, 0.24-0.64), a sensitivity of 52.2% (95% CI, 45.8-58.5), and a specificity of 99.9% (95% CI, 94.5-100). This is based on the assumption that combined reference standards are a valid standard for comparison. CONCLUSIONS Image-guided spinal biopsy is highly specific and performs well in predicting SVOM, but has a moderate accuracy for ruling out this diagnosis. This procedure should be considered in the diagnostic work-up of adults suspected with SVOM.
Collapse
Affiliation(s)
- Jakrapun Pupaibool
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905, USA.
| | - Shawn Vasoo
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905, USA
| | - Patricia J Erwin
- Mayo Clinic Library, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Mohammad Hassan Murad
- Division of Preventive and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905, USA
| | - Elie F Berbari
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905, USA
| |
Collapse
|