Pyogenic Spondylodiscitis: Risk Factors for Adverse Clinical Outcome in Routine Clinical Practice
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Baseline Features
3.2. Clinical Findings
3.3. Microbiology
3.4. Treatment
3.5. Clinical Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Group | Pathogen | Total | Single Organism Isolated | Multiple Organisms Isolated |
---|---|---|---|---|
Gram positive | All | 58 | 46 | 12 |
Staphylococcus aureus | 35 | 33 | 2 | |
Coagulase negative Staphylococci | 11 | 6 | 5 | |
Enterococcus faecalis | 3 | 1 | 2 | |
Streptococcus pneumoniae | 3 | 3 | 0 | |
Viridans group Streptococci | 3 | 1 | 2 | |
Group B Streptococci | 2 | 2 | 0 | |
Group C/G Streptococci | 1 | 0 | 1 | |
Gram negative | All | 17 | 13 | 4 |
Escherichia coli | 11 | 10 | 1 | |
Klebsiella pneumoniae | 2 | 1 | 1 | |
Others | 4 | 2 | 2 | |
Anaerobes | All | 9 | 3 | 6 |
Proprionibacterium acnes | 4 | 2 | 2 | |
Others | 5 | 1 | 4 |
Risk Factor | Total (n = 91) | Favourable Outcome (n = 29) | Unfavourable Outcome 1 (n = 62) | p-Value 2 Univariate Analysis |
---|---|---|---|---|
Background | ||||
Age (median (range)) | 62.5 (17–91) | 59 (17–90) | 64 (35–91) | 0.121 |
Diabetes mellitus (n (%)) | 16 (18) | 1 (3) | 15 (24) | 0.017 * |
Immune compromise (n (%)) | 18 (20) | 3 (10) | 15 (24) | 0.162 |
Post-surgical (n (%)) | 16 (18) | 5 (17) | 11 (18) | >0.99 |
Presenting features | ||||
Sepsis (n (%)) | 22 (24) | 7 (24) | 15 (24) | >0.99 |
Frankel grading scale A–D (n (%)) | 46 (51) | 5 (17) | 39 (63) | <0.001 * |
Duration of symptoms (median days (range)) | 36 (1–203) | 27 (1–71) | 41 (2–203) | 0.049 * |
C-reactive protein (median mg/L (range)) | 170 (4–508) | 143 (15–395) | 181 (4–508) | 0.157 |
White blood cell count (median × 109 (range)) | 13.1 (6.0–33.7) | 12.2 (6.6–24.3) | 13.6 (6.0–33.7) | 0.18 |
Endocarditis | 4 (4) | 1 (3) | 3 (5) | >0.99 |
Radiological features | ||||
Epidural abscess (n (%)) | 55 (60) | 16 (55) | 39 (63) | 0.467 |
Multiple level discitis (n (%)) | 27 (30) | 6 (20) | 21 (34) | 0.228 |
Cord/cauda equina compression (n (%)) | 32 (35) | 5 (17.2) | 27 (44) | 0.018 * |
Vertebral instability (n (%)) | 12 (13) | 2 (7) | 10 (16) | 0.325 |
Microbiological diagnosis | ||||
Bacteraemia (n (%)) | 47 (52) | 18 (62) | 29 (47) | 0.187 |
Staphylococcus aureus (n (%)) | 35 (39) | 10 (35) | 25 (40) | 0.649 |
Risk Factor | Odds Ratio | 95% Confidence Interval | p-Value |
---|---|---|---|
Diabetes mellitus | 5.88 | 1.40–24.68 | 0.008 |
Frankel grading scale A–D | 4.52 | 1.25–16.39 | 0.019 |
Duration of symptoms | 1.02 | 1.00–1.04 | 0.019 |
Spinal cord/cauda equina compression | 6.49 | 1.42–29.70 | 0.009 |
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Widdrington, J.D.; Emmerson, I.; Cullinan, M.; Narayanan, M.; Klejnow, E.; Watson, A.; Ong, E.L.C.; Schmid, M.L.; Price, D.A.; Schwab, U.; et al. Pyogenic Spondylodiscitis: Risk Factors for Adverse Clinical Outcome in Routine Clinical Practice. Med. Sci. 2018, 6, 96. https://doi.org/10.3390/medsci6040096
Widdrington JD, Emmerson I, Cullinan M, Narayanan M, Klejnow E, Watson A, Ong ELC, Schmid ML, Price DA, Schwab U, et al. Pyogenic Spondylodiscitis: Risk Factors for Adverse Clinical Outcome in Routine Clinical Practice. Medical Sciences. 2018; 6(4):96. https://doi.org/10.3390/medsci6040096
Chicago/Turabian StyleWiddrington, John D., Ingrid Emmerson, Milo Cullinan, Manjusha Narayanan, Eleanor Klejnow, Alistair Watson, Edmund L. C. Ong, Matthias L. Schmid, D. Ashley Price, Ulrich Schwab, and et al. 2018. "Pyogenic Spondylodiscitis: Risk Factors for Adverse Clinical Outcome in Routine Clinical Practice" Medical Sciences 6, no. 4: 96. https://doi.org/10.3390/medsci6040096