Influence of microbiological diagnosis on the clinical course of spondylodiscitis

TY - JOUR

T1 - Influence of microbiological diagnosis on the clinical course of spondylodiscitis

AU - Stangenberg, Martin

AU - Mende, Klaus Christian

AU - Mohme, Malte

AU - Krätzig, Theresa

AU - Viezens, Lennart

AU - Both, Anna

AU - Rohde, Holger

AU - Dreimann, Marc

N1 - © 2021. The Author(s).

PY - 2021/10

Y1 - 2021/10

N2 - PURPOSE: This study sought to recognize differences in clinical disease manifestations of spondylodiscitis depending on the causative bacterial species.METHODS: We performed an evaluation of all spondylodiscitis cases in our clinic from 2013-2018. 211 patients were included, in whom a causative bacterial pathogen was identified in 80.6% (170/211). We collected the following data; disease complications, comorbidities, laboratory parameters, abscess occurrence, localization of the infection (cervical, thoracic, lumbar, disseminated), length of hospital stay and 30-day mortality rates depending on the causative bacterial species. Differences between bacterial detection in blood culture and intraoperative samples were also recorded.RESULTS: The detection rate of bacterial pathogens through intraoperative sampling was 66.3% and could be increased by the results of the blood cultures to a total of 80.6% (n = 170/211). S. aureus was the most frequently detected pathogen in blood culture and intraoperative specimens and and was isolated in a higher percentage cervically than in other locations of the spine. Bacteremic S. aureus infections were associated with an increased mortality (31.4% vs. overall mortality of 13.7%, p = 0.001), more frequently developing complications, such as shock, pneumonia, and myocardial infarction. Comorbidities, abscesses, length of stay, sex, and laboratory parameters all showed no differences depending on the bacterial species.CONCLUSION: Blood culture significantly improved the diagnostic yield, thus underscoring the need for a structured diagnostic approach. MSSA spondylodiscitis was associated with increased mortality and a higher incidence of complications.

AB - PURPOSE: This study sought to recognize differences in clinical disease manifestations of spondylodiscitis depending on the causative bacterial species.METHODS: We performed an evaluation of all spondylodiscitis cases in our clinic from 2013-2018. 211 patients were included, in whom a causative bacterial pathogen was identified in 80.6% (170/211). We collected the following data; disease complications, comorbidities, laboratory parameters, abscess occurrence, localization of the infection (cervical, thoracic, lumbar, disseminated), length of hospital stay and 30-day mortality rates depending on the causative bacterial species. Differences between bacterial detection in blood culture and intraoperative samples were also recorded.RESULTS: The detection rate of bacterial pathogens through intraoperative sampling was 66.3% and could be increased by the results of the blood cultures to a total of 80.6% (n = 170/211). S. aureus was the most frequently detected pathogen in blood culture and intraoperative specimens and and was isolated in a higher percentage cervically than in other locations of the spine. Bacteremic S. aureus infections were associated with an increased mortality (31.4% vs. overall mortality of 13.7%, p = 0.001), more frequently developing complications, such as shock, pneumonia, and myocardial infarction. Comorbidities, abscesses, length of stay, sex, and laboratory parameters all showed no differences depending on the bacterial species.CONCLUSION: Blood culture significantly improved the diagnostic yield, thus underscoring the need for a structured diagnostic approach. MSSA spondylodiscitis was associated with increased mortality and a higher incidence of complications.

U2 - 10.1007/s15010-021-01642-5

DO - 10.1007/s15010-021-01642-5

M3 - SCORING: Journal article

C2 - 34254283

VL - 49

SP - 1017

EP - 1027

JO - INFECTION

JF - INFECTION

SN - 0300-8126

IS - 5

ER -