Vertebral osteomyelitis: Clinical, microbiological and radiological characteristics of 116 patients

Autores de IIS La Fe

• Jorge Juan Fragio Gil

  Autor

• Roxana González Mazario

  Autor

• Miguel Salavert Lletí

  Autor

• 

  José Andrés Román Ivorra

  Autor

Grupos

• Infección Grave

  

  Investigador Principal

  María Ángeles Tormo Mas

• Reumatología

  

  Leader

  José Andrés Román Ivorra

Abstract

Introduction/Objectives: To describe the clinical, radiological and microbiological characteristics of vertebral osteomyelitis patients, analysing the factors that played a role on their outcome. Patients and methods: Single-centre retrospective observational study including patients diagnosed with vertebral osteomyelitis, based on the combination of clinical presentation with either a definitive bacteriological diagnosis and/or imaging studies. Results: 116 adult patients were included with a mean age of 62.75 (14.98) years. Males predominated (68.10%). Eighteen patients (15.51%) were immunosuppressed. The most frequent symptom was back pain (99.14%) followed by fever, which was detected in 45 patients (38.79%). Puncture-aspiration or biopsy was performed in 84 patients (72.10%) and its culture was positive in 48 samples (57.14%). Gram positive species predominated (73.86%) on cultures, followed by Gram negative (12.5%), mycobacteria (10.23%) and fungi (3.41%). No microorganism was identified in 28 patients (24.14%). On imaging, most of the patients (92.24%) had paravertebral or epidural abscess. 63 cases (54.31%) showed vertebral destruction and 39 (33.62%) cord compression. Twenty-two patients (18.97%) required further surgical procedures and 13 (11.21%) died. Conclusions: The average patient is middle aged (often male) with a history of subacute back pain, sometimes presenting fever and/or neurological damage on diagnosis. Acute phase reactants are frequently raised. Diabetes mellitus, endocarditis and immunosuppressed patients may have the worst chance of a good outcome, therefore these patients should be more carefully managed (always try to obtain an imaging-guided biopsy, correct antibiotic treatment, and a functional and clinical follow-up). (C) 2020 Elsevier Espana, S.L.U. All rights reserved.

Keywords

• Vertebral osteomyelitis; Spine infection; Back pain; Discitis