Characteristics of and risk factors for severe neurological deficit in patients with pyogenic vertebral osteomyelitis

Lemaignen, Adrien; Ghout, Idir; Dinh, Aurélien; Gras, Guillaume; Fantin, Bruno; Zarrouk, Virginie; Carlier, Robert; Loret, Jean-Edouard; Denès, E.; Greder, Alix; Lescure, François-Xavier; Boutoille, David; Tattevin, Pierre; Issartel, B.; Cottier, Jean‐Philippe; Bernard, Louis

doi:10.1097/md.0000000000006387

Cited by 56 publications

(50 citation statements)

References 29 publications

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“…Pyogenic vertebral osteomyelitis (PVO) presents significant diagnostic and therapeutic challenges, and its incidence appears to be gradually rising [ 1 ]. Clinical outcomes are frequently poor despite surgery and prolonged antibiotic treatment [ 2 , 3 ]. The optimal duration of antibiotic treatment in patients with PVO remains controversial.…”

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confidence: 99%

Epidemiology, Microbiological Diagnosis, and Clinical Outcomes in Pyogenic Vertebral Osteomyelitis: A 10-year Retrospective Cohort Study

Chong

Brereton

Gordon

et al. 2018

Open Forum Infectious Diseases

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BackgroundPyogenic vertebral osteomyelitis (PVO) is rising in incidence, but optimal methods of investigation and duration of antibiotic therapy remain controversial.MethodsWe conducted a single-center retrospective cohort study of PVO at an Australian teaching hospital. We included all adults with a first episode of PVO between 2006 and 2015. PVO was defined based on the presence of prespecified clinical and radiological criteria. The main exposures of interest were investigation strategy and antibiotic treatment. The main outcome measures were duration of hospital admission, mortality during index admission, symptom resolution during index admission, and attributable readmission within 2 years.ResultsOf 129 included patients, 101 (78%) had a causative organism identified. Patients with an identified pathogen were more likely to be febrile (75% compared with 29%, P < .001) and had a higher mean admission C-reactive protein (207 vs 54, P < .001) compared with patients without an identified pathogen. However, they were less likely to experience an adverse outcome (death or attributable readmission within 2 years; adjusted odds ratio, 0.36; 95% confidence interval, 0.13–0.99; P = .04). Open biopsy of vertebral tissue had a higher diagnostic yield (70%) than fine needle aspirate (41%) or core biopsy (30%). Despite receiving a median of 6 weeks of intravenous antibiotics, only 15% of patients had a full recovery on discharge from index admission.ConclusionsClinical outcomes for patients with PVO were poor. Obtaining a microbiological diagnosis is associated with a better outcome. However, prospective and randomized studies are essential to establishing optimal investigation and treatment pathways.

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confidence: 99%

Epidemiology, Microbiological Diagnosis, and Clinical Outcomes in Pyogenic Vertebral Osteomyelitis: A 10-year Retrospective Cohort Study

Chong

Brereton

Gordon

et al. 2018

Open Forum Infectious Diseases

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“…As for the risk factors associated with symptoms of severe neurological deficit, Lemaignen et al, 10 in their case-control study with three hundred and seventy-eight patients, concluded that the factors associated with worse neurological prognosis are a Charlson Score 11 higher than five points, severity of the initial motor weakness (Frankel A and B), and involvement of the thoracic spine. Furthermore, they associated involvement of the lumbar spine with a favorable outcome.…”

Section: Discussionmentioning

confidence: 99%

Nonspecific Spondylodiscitis in Adults: Retrospective Study

et al. 2020

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Objective To describe the epidemiological and clinical characteristics of patients with pyogenic spondylodiscitis treated in a Brazilian hospital. Methods This is a retrospective study of patients diagnosed with nonspecific spondylodiscitis. Patients of both sexes, above 18 years of age with a minimum follow-up time of 6 months were included. Epidemiological, laboratory, and clinical data were analyzed. Results Nine patients were included. The mean age was 64 years, with seven men (77.7%) and two women (22.2%). All patients evaluated had back pain. The most affected location was the lumbar spine (44.4%). Only three patients (33.3%) had fever and five (55%) had constitutional symptoms. The mean duration of symptoms before diagnosis was 2.5 (± 1.5) weeks. Only four patients (44.4%) had positive cultures. As for neurological status, five patients (55.5%) presented neurological change. At the end of treatment, two patients improved one level in the Frankel score and two patients improved two levels. The main indication for surgery was neurological deficit (55.5%). Two of the patients evaluated died as a result of an infectious condition. Conclusions Less than half of the patients with pyogenic spondylodiscitis had fever or constitutional symptoms. Back pain was present in all cases. In less than half of the patients it was possible to isolate the responsible microorganism. Most patients underwent surgical treatment, although not all improved from the neurological deficit. Level of evidence II; Retrospective study.

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“…In this study, where the average level of CRP was reported to be 150 mg / L, it was indicated that the duration of antibiotic treatment was not associated with functional improvement. It was also pointed out that the exact effect of optimal surgery and / or corticosteroid therapy should be demonstrated in further studies (24).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Neutrophil-to-lymphocyte ratio as a marker of inflammatory response in Spondylodiscitis

Karaarslan¹,

Yılmaz²,

Akgün³

et al. 2018

J Turgut Ozal Med Cent

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Aim: Spondylodiscitis, if not diagnosed on time, can cause morbidity or mortality at high rates. This study was carried out with the aim of testing the hypothesis that "neutrophil-to-lymphocyte ratio can be used" especially in cases where it is difficult to diagnose spondylodiscitis. Material and Methods: This study involved 24 patients admitted to the State Hospital of Ministry of Health and Namik Kemal University for spondylodiscitis between January2014 and June2017. After excluding the cases that did not meet the inclusion criteria (n=6), the remaining cases (n=24) were referred to as the study group. A control group was created from healthy volunteers (n=24) who applied for routine physical checkups at the clinic between the same dates and who were similar in terms of age, sex, and body mass index to the study group. Hemogram parameters of the cases in both groups; white blood cell, C-reactive protein, erythrocyte sedimentation rate, and neutrophil-to-lymphocyte ratio were statistically compared. Results: Patients in the spondylodiscitis group, compared to healthy volunteers had statistically significant neutrophil-to-lymphocyte ratio value. Conclusion: Especially in cases where the diagnosis of spondylodiscitis is not assured, the neutrophil-to-lymphocyte ratio parameter, which is less costly than other diagnostic methods and the analysis results of which can be obtained in a shorter time, may be used to support clinical diagnosis.

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Characteristics of and risk factors for severe neurological deficit in patients with pyogenic vertebral osteomyelitis

Abstract: Supplemental Digital Content is available in the text

Cited by 56 publications

References 29 publications

Epidemiology, Microbiological Diagnosis, and Clinical Outcomes in Pyogenic Vertebral Osteomyelitis: A 10-year Retrospective Cohort Study

Epidemiology, Microbiological Diagnosis, and Clinical Outcomes in Pyogenic Vertebral Osteomyelitis: A 10-year Retrospective Cohort Study

Nonspecific Spondylodiscitis in Adults: Retrospective Study

Evaluation of Neutrophil-to-lymphocyte ratio as a marker of inflammatory response in Spondylodiscitis

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