Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Vertebral Osteomyelitis is an infectious disease of the vertebral body which could involve the intervertebral space (spondylodiscitis). Early diagnosis and treatment are essential in order to achieve the best chance of a good outcome, but these are often delayed because it tends to present nonspecific manifestations. Our purpose was to identify risk factors and outcome variables in our cohort.
Methods: Single center longitudinal retrospective observational study including patients diagnosed of Vertebral Osteomyelitis from January 2010 to March 2018. Demographic, clinical, microbiology and radiological data were compiled. Long hospital stay, readmission, vertebral destruction, neurological damage and death were chosen as outcome variables. Patients aging under 18 were excluded. The statistical analysis was performed with the software R, version 3.3.2.
Results: 116 patients were included, with a mean age of 62.05 (16.94) years old. Male sex accounted 68.10%. 58.62% had medical history of spine pathology. 18 patients (15.51%) presented immunosuppression (rheumatic or inflammatory bowel disease on treament, malignancy, HIV or solid organ transplantation). Most frequent symptom was back pain (99.14%), fever was only in 45 patients (38.79%). Acute paraparesis was presented in 21 patients (19.10%) at diagnosis. Mean diagnosis deay was 54.14 days. 14 patients had underlying endocarditis (12.07%). Most of patients (94.83%) showed high CRP levels at diagnosis, with an average value of 103.47 mg/L, which was not related to worse outcome. Mean length of hospital stay was 34.24 (34.3) days and readmission rate was 34.9%. Blood cultures were positive in 46 patients (39.66%). Punction-aspiration was performed in 84 patients (72.10%) and its culture were positive in 48 samples (57.14%). Median delay from suspicion to biopsy was 6 days. Gram positive predominated (73.86%), followed by Gram negative species (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. Vertebral destruction was related to epidural abscess (p=0.006). 22 patients (18.97%) required further surgical procedures. Age trend to be related to worse outcome with no statistical signification. Diabetes mellitus was associated to greater vertebral destruction (p=0.01) and cord compression (p=0.02). Longer pain duration correlated with neurological damage (p=0.02). Underlying infectious endocarditis patients showed higher vertebral destruction (p=0.01). 11 patients (9.48%) died during follow-up.
Conclusion: Delay in diagnosis is still an important issue that is associated to higher complication rates, mainly related to structural damage of the spine. It has been also found that the presence of an epidural vertebral abscess is related to greater vertebral destruction. Elderly, diabetic and immunosuppressed patients had the worse chance of a good outcome, so these patients should be more careful managed (always try to obtain an imaging-guided biopsy, correct antibiotic treatment, and a functional and clinical follow-up).
To cite this abstract in AMA style:Fragio Gil JJ, Gonzalez Mazario R, Ortiz-Sanjuán FM, Ivorra Cortes J, Grau Garcia E, Arevalo K, Martinez Cordellat I, Chalmeta Verdejo I, Oller Rodriguez JE, Gonzalez Puig L, De la Rubia Navarro M, Negueroles Albuixech R, Alcañiz Escandell C, Vicens Bernabeu E, Calabuig E, Tasias Pitarch M, Salavert Lleti M, Roman Ivorra JA. Pyogenic Vertebral Osteomyelitis: Outcome Variables Analysis in a 116 Patients Cohort at a Tertiary Hospital during the Last 8 YEARS [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/pyogenic-vertebral-osteomyelitis-outcome-variables-analysis-in-a-116-patients-cohort-at-a-tertiary-hospital-during-the-last-8-years/. Accessed January 20, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pyogenic-vertebral-osteomyelitis-outcome-variables-analysis-in-a-116-patients-cohort-at-a-tertiary-hospital-during-the-last-8-years/