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. 2021 Oct;49(5):1017-1027.
doi: 10.1007/s15010-021-01642-5. Epub 2021 Jul 12.

Influence of microbiological diagnosis on the clinical course of spondylodiscitis

Martin Stangenberg  1 , Klaus Christian Mende  2 , Malte Mohme  2 , Theresa Krätzig  2 , Lennart Viezens  3 , Anna Both  4 , Holger Rohde  4 , Marc Dreimann  3
Affiliations

Influence of microbiological diagnosis on the clinical course of spondylodiscitis

Martin Stangenberg et al. Infection. 2021 Oct.

Abstract

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.

Keywords: Microbiology; Risk factors; Spondylodiscitis; Staphylococcus aureus; Vertebral osteomyelitis.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Structured approach for diagnosis and therapy of spondylodiscitis
Fig. 2
Fig. 2
Complications by blood culture results. *p < 0.05; **p < 0.01; ***p < 0.001
Fig. 3
Fig. 3
Complications by intraoperative tissue results. *p < 0.05; **p < 0.01; ***p < 0.001
See this image and copyright information in PMC

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