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Pantel T, Mende KC, Stangenberg M, Mohme M, Mohme T, Floeth F, Eicker SO, Dreimann M. Regional Spondylodiscitis Disparities: Impact on Pathogen Spectrum and Patients. J Clin Med 2024; 13:2557. [PMID: 38731085 PMCID: PMC11084223 DOI: 10.3390/jcm13092557] [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: 03/12/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Spondylodiscitis is an infectious disease affecting an intervertebral disc and the adjacent vertebral bodies and is often the complication of a distant focus of infection. This study aims to ascertain the regional and hospital-specific disparities in bacterial patterns and resistance profiles in spontaneous and iatrogenic spondylodiscitis and their implications for patient treatment. Methods: We enrolled patients from two German hospitals, specifically comparing a university hospital (UVH) with a peripheral non-university hospital (NUH). We documented patient demographics, laboratory results, and surgical interventions. Microbiological assessments, antibiotic regimens, treatment durations, and resistance profiles were recorded. Results: This study included 135 patients. Upon admission, 92.4% reported pain, with 16.2% also presenting neurological deficits. The primary microbial species identified in both the UVH and NUH cohorts were S. aureus (37.3% vs. 31.3%) and cog. neg. staphylococci (28.8% vs. 34.4%), respectively. Notably, a higher prevalence of resistant bacteria was noted in the UVH group (p < 0.001). Additionally, concomitant malignancies were significantly more prevalent in the UVH cohort. Conclusion: Significant regional variations exist in bacterial prevalence and resistance profiles. Consequently, treatment protocols need to consider these nuances and undergo regular critical evaluation. Moreover, patients with concurrent malignancies face an elevated risk of spondylodiscitis.
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Affiliation(s)
- Tobias Pantel
- Department of Neurosurgery, Hamburg University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - Klaus Christian Mende
- Department of Neurosurgery, Hamburg University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
- Department of Neurosurgery, Friedrich-Ebert-Krankenhaus, Friesenstr. 11, 24534 Neumünster, Germany
| | - Martin Stangenberg
- Department of Trauma and Orthopedic Surgery, Hamburg University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
- Department of Spine and Neurosurgery, Tabea Krankenhaus Hamburg, Kösterbergstraße 32, 22587 Hamburg, Germany
| | - Malte Mohme
- Department of Neurosurgery, Hamburg University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - Theresa Mohme
- Department of Neurosurgery, Hamburg University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
- Wirbelwerk Hamburg, Orchideenstieg 12, 22297 Hamburg, Germany
| | - Frank Floeth
- Department of Spinal Surgery, Hospital zum Heiligen Geist, Von-Broichhausen-Allee 1, 47906 Kempen, Germany
| | - Sven Oliver Eicker
- Department of Neurosurgery, Hamburg University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
- Department of Spine and Scoliosis Surgery, Lubinus Clinicum, Steenbeker Weg 25, 24106 Kiel, Germany
| | - Marc Dreimann
- Department of Trauma and Orthopedic Surgery, Hamburg University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
- Department of Spine, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany
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Kalmoukos P, Kouroupis D, Sapouridis G, Simoulidou E, Varouktsi A, Zarras C, Petidis K, Pyrpasopoulou A. Anaerobic Spondylodiscitis caused by Parvimonas Micra in a Rheumatoid Arthritis Patient: Case Report and Review of the Literature. Mediterr J Rheumatol 2023; 34:525-530. [PMID: 38282925 PMCID: PMC10815523 DOI: 10.31138/mjr.240823.asc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/03/2023] [Accepted: 06/18/2023] [Indexed: 01/30/2024] Open
Abstract
We report the rare case of Parvimonas micra bacteraemia and secondary spondylodiscitis probably triggered by tooth injury in a rheumatoid arthritis patient. Anaerobic bacteria associated spondylodiscitis may evade diagnosis due to atypical clinical presentation usually lacking fever, and the difficulties related to microbiological characterisation of the pathogen. Even though anaerobic spinal infections may constitute <3% of the total, clinical suspicion should remain high, especially in the case of positive history for pre-existing oral cavity or gastrointestinal/gynaecological tract infections.
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Affiliation(s)
| | | | | | | | | | - Charalampos Zarras
- Lab of Microbiology, Hippokration Hospital Thessaloniki, Thessaloniki, Greece
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Ohyama S, Inoue M, Toshi N, Okuyama K, Tokeshi S, Suzuki N, Shiga Y, Inage K, Yawara E, Orita S, Ohtori S. Retroperitoneal Continuous Local Antibiotic Perfusion for Refractory Pyogenic Vertebral Osteomyelitis: A Case Report. Cureus 2023; 15:e50636. [PMID: 38226091 PMCID: PMC10789547 DOI: 10.7759/cureus.50636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/17/2024] Open
Abstract
Pyogenic vertebral osteomyelitis (PVO) is a prevalent infection in the elderly, frequently complicated by iliopsoas and epidural abscesses. Traditional treatments are often ineffective for refractory cases. In this report, a 76-year-old man with PVO, iliopsoas, and epidural abscess was unresponsive to antibiotics, presenting with severe lower back pain and functional impairments. A two-stage surgical intervention was implemented: anterior debridement, autogenous bone graft fixation, and novel application of retroperitoneal continuous local antibiotic perfusion (CLAP), followed by posterior fixation. A contrast test verified correct CLAP perfusion into the iliopsoas abscess and intervertebral disc space. Substantial improvements were noted postoperatively, including a marked reduction in pain, inflammation, and the size of both abscesses. In conclusion, this case demonstrates the feasibility and effectiveness of retroperitoneal CLAP in treating refractory PVO, offering a potential innovative solution for cases resistant to conventional therapies.
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Affiliation(s)
- Shuhei Ohyama
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Masahiro Inoue
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Noriyasu Toshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Kohei Okuyama
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Soichiro Tokeshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Noritaka Suzuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Yasuhiro Shiga
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Eguchi Yawara
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
- Department of Orthopedic Surgery, Center for Frontier Medical Engineering, Chiba University, Chiba, JPN
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
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