Article
Septic shock in spondylodiscitis: better survival with critical tretment strategies
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Published: | June 9, 2017 |
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Objective: Septic shock represents a formidable complication of spondylodiscitis. Despite advances in surgical and intensive care treatment, it is still burdened by high morbidity and mortality. Here, we present our experience in the treatment of this emergency over a 10-year period.
Methods: Eight patients with spondylodiscitis complicated by septic shock were identified in our department from 2005 until 2016. Clinical, laboratory and radiological data were analyzed retrospectively.
Results: There were 7 men and 1 woman. Age ranged between 53 und 78 years (mean age: 62 years). All patients had a history of chronic disease: diabetes mellitus (3 patients), malignancies (2 patients), cardiovascular diseases (5 patients: arterial hypertension, cardiomyopathy, arrhythmia, valvopathies). Six patients presented with paraparesis. Besides spondylodiscitis, intraspinal and/or paravertebral abscesses were evident on MRI imaging studies in all patients. Surgery was performed in all cases including decompression of the abscesses and of the spinal canal. Bacteria were isolated in blood cultures in only 3 patients, and in samples obtained during surgery in 6 patients. Isolated bacteria were gram positive in 6 patients and gram negative in one patient. The mean duration of stay in the intensive unit was 21 days. The clinical course was complicated with respiratory failure (ARDS, in 5 patients) and renal failure (in all patients). Reanimation was necessary in one patient. Another patient succumbed due to septic shock and multi-organ failure. Seven Patients could be referred to rehabilitation in a stable condition.
Conclusion: The management of septic shock in spondylodiscitis needs an interdisciplinary team work. Surgery is necessary for decompression but it also allows determining the causal bacteria and the optimal antibiotic regimen in patients with negative blood culture. Aggressive treatment strategies might result in an increase of the survival.