Evaluation of Patients Diagnosed with Spondylodiscitis

Abstract

Objective: Spondylodiscitis is an infectious disease that affects the vertebral body, intervertebral disc, and/or adjacent paraspinal tissue, and it is a significant cause of morbidity, especially in older individuals. This study aims to evaluate cases of spondylodiscitis followed at ** Hospital. Material and Method: Between January 2017 and December 2021, the medical records and electronic files of patients who began antimicrobial treatment with a diagnosis of spondylodiscitis at Suleyman Demirel University Hospital were retrospectively evaluated. Results: A total of 33 patients were included in the study, consisting of 17 females and 16 males. The average age of the patients was 56.0 ± 13.6 years. Twenty patients (60.6%) were hospitalized, while 13 patients (39.4%) were followed as outpatients. Spinal surgery due to discopathy was performed in 9 cases (27.3%), and 4 of these patients had a history of recurrent surgical interventions. The most commonly affected region was the lumbar vertebrae (44.1%). The lumbosacral region (20.6%) and thoracolumbar region (14.7%) followed as the second and third most affected areas, respectively. Brucellosis complications were present in 14 cases (42.4%) of spondylodiscitis. Pyogenic microorganisms and tuberculosis were responsible for the remaining 11 (33,3%), and 2 (6%) patients respectively. In 11 patients (33.3.%), the causative microorganism was identified in tissue/abscess/blood cultures as methicillin-sensitive Staphylococcus aureus (3), methicillin-resistant coagulase-negative Staphylococcus (1), methicillin-resistant S. aureus (1), methicillin-sensitive coagulase-negative Staphylococcus (1), Klebsiella pneumonia (2), Enterococcus faecalis (2), Acinetobacter spp. (1), Escherichia coli (1). Staphylococcus aureus (12%) was the most common pathogen among pyogenic microorganisms. In one case, the identified pathogen was Mycobacterium tuberculosis. One of the patients was considered to have tuberculosis spondylodiscitis based on histopathological evaluation. Conclusion: The fact that nearly half of spondylodiscitis cases observed in our hospital were complicated by brucellosis indicates the importance of evaluating patients presenting with back pain for brucellosis. Collaborative training programs with surgical specialities should be periodically repeated to prevent cases of spondylodiscitis that develop after spinal surgeries.

Keywords

• Spondylodiscitis
• brucellosis
• Staphylococcus aureus
• Mycobacterium tuberculosis

References

1. 1. Mavrogenis AF, Megaloikonomos PD, Igoumenou VG, et al. Spondylodiscitis revisited. EFORT Open Rev 2017;15;2(11):447-461. doi: 10.1302/2058-5241.2.160062
2. 2. Babic M, Simpfendorfer CS. Infections of the Spine. Infect Dis Clin North Am 2017;31(2):279-297. doi:10.1016/j.idc.2017.01.003
3. 3. Kehrer M, Pedersen C, Jensen TG, et al. Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. The Journal of Infection 2014;68(4):313-320. doi:10.1016/j.jinf.2013.11.011
4. 4. Bass SN, Ailani RK, Shekar R, et al. Pyogenic vertebral osteomyelitis presenting as exudative pleural effusion: a series of five cases. Chest 1998;114(2):642-647. doi:10.1378/chest.114.2.642
5. 5. Berbari EF, Kanj SS, Kowalski TJ, et al. 2015 Infectious diseases society of America (IDSA) Clinical Practice Guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis 2015;61(6):e26-e46. doi:10.1093/cid/civ482
6. 6. Kleck CCJ, Damioli L, Ou-Yang D. Treatment of Spinal Infections. Instr Course Lect 2024;73:675-687. PMID: 38090933.
7. 7. Pro-Implant Foundation [Internet]. Pocket Guide to Diagnosis & Treatment of Periprosthetic Joint Infection (PJI) Version 11. [Updated 2023 November; cited 2024 Jan 3]. Available from: https://pro-implant.org/tools/pocket-guide/1
8. 8. Trisha Peel, MD, MBBS.Vertebral osteomyelitis and discitis in adults [Internet]. Update. [Last updated: 2022 Aug 16, cited 2024 May 23:]. Available from: https://www.uptodate.com/contents/vertebral-osteomyelitis-and-discitis-in-adults?search=vertebal%20osteo&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1

9. 9. Centers for Disease Control and Prevention. 2017. Brucellosis reference guide: exposures, testing, and prevention. Available from: https://www.cdc.gov/brucellosis/pdf/brucellosi-reference-guide.pdf.
10. 10. Gul HC, Erdem H. Brucellosis (Brucella Species). In: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, edited by John E. Bennett, Raphael Dolin and Martin J. Blaser. 9th Edition Vol. 2. Elsevier; 2019. p. 2753–758.
11. 11. Pappas G, Akritidis N, Bosilkovski M, et al. Brucellosis. N Engl J Med 2005; 352(22), 2325-2336. doi:10.1056/NEJMra050570
12. 12. Yang XM, Jia YL, Zhang Y, et al. Clinical effect of doxycycline combined with compound sulfamethoxazole and rifampicin in the treatment of brucellosis spondylitis. Drug Des Devel Ther 2021;15:4733-40.
13. 13. Salaffi F, Ceccarelli L, Carotti M, et al. Differentiation between infectious spondylodiscitis versus inflammatory or degenerative spinal changes: How can magnetic resonance imaging help the clinician? Radiol Med 2021;126(6):843-859. doi: 10.1007/s11547-021-01347-7
14. 14. Issa K, Diebo BG, Faloon M, et al. The epidemiology of vertebral osteomyelitis in the United States from 1998 to 2013. Clin Spine Surg 2018;31(2):E102-E108. doi:10.1097/BSD.0000000000000597
15. 15. Nolla JM, Ariza J, Gómez-Vaquero C, et al. Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum 2002;31(4):271-278. doi:10.1053/sarh.2002.29492
16. 16. Hatipoğlu ÇA, Arslan K, Bulut C, et al. Spondilodiskitli hastaların epidemiyolojik, klinik ve laboratuvar özelliklerinin değerlendirilmesi. Flora 2013;1:28-33.
17. 17. Hamidi AA, Özsüt H, Başaran S, et al. Tüberkülöz, pyojenik ve brucella’ya bağlı spondilodiskit: 103 olgunun klinik ve laboratuvar özellikleri. Klimik Dergisi 2015;28:80-6. doi: 10.5152/kd.2015.15
18. 18. Kaya S, Kaya S, Kavak S, et al. A disease that is difficult to diagnose and treat: evaluation of 343 spondylodiscitis cases. J Int Med Res 2021;49(11):3000605211060197. doi:10.1177/03000605211060197
19. 19. Mete B, Kurt C, Yilmaz MH, et al. Vertebral osteomyelitis: eight years experience of 100 cases. Rheumatol Int 2012;32(11):3591-3597. doi:10.1007/s00296-011-2233-z
20. 20. Turunc T, Demiroglu YZ, Uncu H, et al. A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect 2007;55(2):158-163. doi:10.1016/j.jinf.2007.04.002
21. 21. Dholoo F, Sriramanarayanan A, Prasad SPK, et al. Spondylodiscitis cohort analysis of its identification and management. Int Orthop 2023;47(3):813-818. doi:10.1007/s00264-022-05662-0
22. 22. Conan Y, Laurent E, Belin Y, et al. Large increase of vertebral osteomyelitis in France: a 2010-2019 cross-sectional study. Epidemiol Infect 2021;149:e227. doi: 10.1017/S0950268821002181
23. 23. Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004;24-30;364(9431):369-79. doi: 10.1016/S0140-6736(04)16727-5
24. 24. Gentile L, Benazzo F, De Rosa F, et al. A systematic review: characteristics, complications and treatment of spondylodiscitis. Eur Rev Med Pharmacol Sci 2019;23(2):117-128. doi:10.26355/eurrev_201904_17481
25. 25. Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 2010;65(3):11-24. doi:10.1093/jac/dkq303
26. 26. Pappas G, Papadimitriou P, Akritidis N, et al. The new global map of human brucellosis. Lancet Infect Dis 2006;6(2):91-99. doi:10.1016/S1473-3099(06)70382-6
27. 27. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Zoonotik ve Vektörel Hastalıklar Dairesi Başkanlığı. [2017]-[Cited 2024 Jan 3]. Available from: https://hsgm.saglik.gov.tr/depo/birimler/zoonotik-ve-vektorel-hastaliklar db/Dokumanlar/Istatistikler/Web_Bruselloz_haritasi.pdf
28. 28. Akcam FZ, Kaya O, Ceylan T. Comment on: Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 2011;66(5):1199-1202. doi:10.1093/jac/dkq532