Article
Clinical characteristics and management of pyogenic spinal infections – a retrospective study
Klinische Krankheitsmerkmale und Management der pyogenen Wirbelsäuleninfektionen: eine retrospektive Studie
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Authors
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Mido Max Hijazi
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Silke Hennig
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Patrick Glatte
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Tareq Juratli
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Ibrahim El-battrawy
- Universitätsklinikum Bochum, Kardiologie, Bochum, Deutschland
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Gabriele Schackert
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Dino Podlesek
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: The incidence of pyogenic spondylodiscitis and epidural empyema has been increasing, due to the rising numbers of immunosuppressed patients. The clinical features of epidural empyema and spondylodiscitis differ in many aspects. In this retrospective study, we analyzed clinical data of a large cohort of patients with pyogenic spinal infections.
Methods: Data from 120 patients (79 men, 41 women; median age: 68 y) who underwent treatment in our hospital between 2016 and 2021 were analyzed. The patients have been diagnosed with isolated spondylodiscitis (n=16, 13.3%), epidural empyema (n=30, 25%) or spondylodiscitis with epidural empyema (n=74, 61.7%). Clinical, radiographic, microbiological and demographic data were evaluated.
Results: Pyogenic spinal infections occurred predominantly in male patients (65.8%). Males were significantly younger than females at the time point of diagnosis (men: 66y, women: 75y, p= 0.027). 116 patients underwent surgical treatment (empyema debridement with/without stabilization), three patients were biopsied, while one patient remained under conservative therapy. Patients with isolated epidural empyema without discitis developed significantly less often (16.7%) sepsis in the disease course, compared with their counterparts with discitis (discitis with empyema 54.1%, isolated discitis 62.5%, p= 0.001). Methicillin-sensitive Staphylococcus aureus (MSSA) represented the most frequently isolated pathogen (47.5%) in our study. In addition, we found Candida albicans infections in 3.3% of patients, which was associated with a significantly longer hospital stay (58 vs. 31 days, p= 0.005). In 3% of patients, the isolation of a pathogen failed due to an upfront empiric antibiotic therapy.
Conclusion: Pyogenic spinal infections comprise heterogeneous disease groups with distinct clinical features and outcome. In our study, epidural empyema patients showed a more favorable disease course than patients with discitis. MSSA represented the most frequently isolated pathogen in pyogenic spinal infections, while fungal spinal infections are underestimated and often co-occur with other bacterial infections.
