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Open AccessArticle

Pyogenic Spondylodiscitis: Risk Factors for Adverse Clinical Outcome in Routine Clinical Practice

1
Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
2
Clinical Research Department, South Tyneside Hospital, Harton Lane, South Tyneside NE34 0PL, UK
3
Department of Microbiology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
4
Institute of Cellular Medicine, Inflammation, Immunology and Immunotherapy Theme, Room M3.119, William Leech Building, Newcastle University Medical School, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
Med. Sci. 2018, 6(4), 96; https://doi.org/10.3390/medsci6040096
Received: 12 September 2018 / Revised: 17 October 2018 / Accepted: 23 October 2018 / Published: 30 October 2018
(This article belongs to the Section Immunology and Infectious Diseases)
We aimed to describe the clinical features and outcomes of pyogenic spondylodiscitis and to identify factors associated with an unfavourable clinical outcome (defined as death, permanent disability, spinal instability or persistent pain). In our tertiary centre, 91 cases were identified prospectively and a retrospective descriptive analysis of clinical records was performed prior to binary regression analysis of factors associated with an unfavourable outcome. A median 26 days elapsed from the onset of symptoms to diagnosis and 51% of patients had neurological impairment at presentation. A microbiological diagnosis was reached in 81%, with Staphylococcus aureus most commonly isolated. Treatment involved prolonged hospitalisation (median stay 40.5 days), long courses of antibiotics (>6 weeks in 98%) and surgery in 42%. While this was successful in eradicating infection, only 32% of patients had a favourable clinical outcome and six patients (7%) died. Diabetes mellitus, clinical evidence of neurological impairment at presentation, a longer duration of symptoms and radiological evidence of spinal cord or cauda equina compression were independent factors associated with an unfavourable outcome. Our data indicate that spondylodiscitis is associated with significant morbidity and suggest that adverse outcomes may be predicted to an extent by factors present at the time of diagnosis. View Full-Text
Keywords: spondylodiscitis; vertebral osteomyelitis; bacterial; antibiotics; outcomes spondylodiscitis; vertebral osteomyelitis; bacterial; antibiotics; outcomes
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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.; Duncan, C.J.A. Pyogenic Spondylodiscitis: Risk Factors for Adverse Clinical Outcome in Routine Clinical Practice. Med. Sci. 2018, 6, 96.

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