Background Infectious spondylodiscitis is infection involving the intervertebral disc and contiguous vertebrae. Nowadays, cases of infectious spondylodiscitis are increasing . Therefore it is important to include infectious spondylodiscitis in the differential diagnosis of low back pain.
Objectives To analyse the characteristics of infectious spondylodiscitis in patients treated in rheumatology department focusing upon clinical, bacteriological, therapeutical aspects and treatment outcomes.
Methods A retrospective monocentric study involving 82 cases of infectious spondylodiscitis admitted between January 2010 and December 2014 at the rheumatology department in Hospital of Lithuanian University of Health Sciences. Demographic characteristics, risk factors, underlying diseases, microorganism agents, different treatment, duration of treatment and outcome were recorded.
Results Eighty two patients are included in this study. There were 42 males (51.22%) and 40 females (48.78%). The mean age was 64.22 years, ranged from 30 to 86 years. No microorganism agent was found in 65.85% of patients (n=54). Microorganism agent was identified in 34.15% of patients (n=28) according to positive blood culture. Staphylococcus aureus was found in 50% of cases (n=14), Escherichia coli in 14.29% (n=4), MRSA in 7.14% (n=2). 58.54% of patients had sources of infection and 43.75% of them had septicaemia. In 65.85% of cases (n=54) patients felt a fever. 37,81% (n=31) of patients immune system was suppressed: 38.71% of them had diabetes mellitus type 2 (n=12), 41.94% oncology disease (n=13), 19.35% used glucocorticoids (n=6). In all cases 100% (n=82) patients felt affected area pain (neck, back pain). The most common affected place is lumbal vertebrae 82.9%. All patients were treated with intravenous antibiotics, in two cases also was applied surgical treatment. 48.78% of patients were treated with first generation cephalosporins, 39.0% of patients were treated with second generation cephalosporins, 32.93% of patients were treated with penicillin antibiotics, 12.20% of patients were treated with penicillin and beta-lactamase inhibitor combinations. Also 40.24% of patients additionally had metronidazole, 26.83% vancomycin and 15.85% clindamycin. The mean duration of intravenous treatment with antibiotics was 29 days. 12.20% patients had relapsed, 2 died. The period from onset of symptoms to diagnosis confirmation is between 1 and 24 weeks. Underlying rheumatic diseases were found in 46.3% of patients (n=38). 29.2% of patients had osteochondrosis, 11.0% gout and 6.1% rheumatoid arthritis.
Conclusions The diagnosis of infectious spondylodiscitis are often delayed. Usually in less than half of cases it is possible to identify causative agent therefore broad-spectrum antibiotics are prescribed.
Kehrer M, Pedersen C, Jensen TG, Lassen AT. Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. Journal of infection 2014 Apr;68(4):313-320.
Disclosure of Interest None declared