Pyogenic and Tuberculous Spondylodiskitis (Vertebral Osteomyelitis) in 80 Adult Patients

Perronne, C.; Saba, Joseph; Behloul, Z; Salmon‐Céron, Dominique; Leport, Catherine; Vildé, Jean Louis; Kahn, M F

doi:10.1093/clinids/19.4.746

Cited by 230 publications

(156 citation statements)

References 14 publications

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“…Another potential factor to consider in this series is the number of patients with a history of vertebral surgery. Consistent with current data, this is classically associated with a high prevalence of CoNS pathogens (1,2,23,29). Molecular typing allowed us to refine these observations by pinpointing the wide spectrum of staphylococcal species associated with discitis.…”

Section: Diagnosing Infectious Discitis By Dna Analysissupporting

confidence: 81%

“…Further identification of infecting bacteria then relies on sequence analysis of amplicons. We decided to design a gram-positive/ gram-negative-specific (rather than a broad) 16S rDNA assay for 3 reasons: 1) the gram-specific amplification strategy appears to be more sensitive than a previous universal 16S rDNA PCR designed in our laboratory (data not shown); 2) exact Gram stain classification by PCR may guide therapeutic decisions; and 3) considering the reported high prevalence of staphylococci in discitis (1,2,23,29), a combination of gram-positive and femA staphylococcal species-specific target genes, as well as a staphylococcal methicillin resistance mecA gene in femA-positive samples, yields a high degree of complementarity. Some samples generated femA amplicons, but no (patient 1) or only very weak (patients 2 and 11) 16S rDNA amplicons, because of the higher sensitivity of a nested femA amplification.…”

Section: Diagnosing Infectious Discitis By Dna Analysismentioning

confidence: 99%

“…Infectious spondylodiscitis consists of concurrent infection of the intervertebral disc and adjacent vertebral osteomyelitis, observed spontaneously or after invasive spinal procedures or surgery (1)(2)(3). Magnetic resonance imaging (MRI) is the diagnostic technique of choice, with sensitivity and specificity of 96% and 94%, respectively, whereas radiographic abnormalities only appear several weeks or months after clinical symptoms (4,5).…”

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confidence: 99%

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The etiologic diagnosis of infectious discitis is improved by amplification‐based DNA analysis

Lecouvet¹,

Irenge²,

Vandercam³

et al. 2004

Arthritis & Rheumatism

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Objective. Blood cultures and cultures of disc material are required to identify and treat bacterial agents responsible for septic spondylodiscitis, but these methods have limited sensitivities. We undertook this study to compare nonculture amplification-based DNA analysis with conventional culture of disc aspirate.Methods. Nineteen patients with spondylodiscitis, including 11 with a history of spinal surgery, presented with negative blood cultures and underwent percutaneous disc or epidural abscess puncture for bacterial diagnosis. Amplification by polymerase chain reaction was performed on 16S ribosomal DNA universal target genes and femA staphylococci-specific target genes in all patients, and on the upstream p34 mycobacterial gene in 1 patient. Species identification relied on amplicon sequencing and comparison with templates from GenBank. Amplification of the femA gene led to subsequent testing for methicillin resistance by amplification of the mecA gene. Further assessment using a staphylococciand methicillin resistance-specific DNA array was performed on 3 samples.Results. Microbiologic and molecular assays identified the causative organism in 14 of 19 patients (74%) and 19 of 19 patients (100%), respectively. In culture-positive patients, DNA-based and microbiologic results were highly correlated. Five agents (Staphylococcus simulans, Staphylococcus sciuri, Brucella species, Actinomyces israelii, and Mycobacterium tuberculosis complex) were identified only by DNA-based methods. In 1 sample, Corynebacterium jeikeium and coagulasenegative Staphylococcus were both cultured, whereas DNA analysis identified only Staphylococcus hominis.Conclusion. DNA-based methods are highly sensitive and specific. They can usefully complement standard microbiologic methods for identifying the cause of infectious spondylodiscitis and contribute to speciesspecific therapeutic orientation in patients with negative blood and disc aspirate cultures.Infectious spondylodiscitis consists of concurrent infection of the intervertebral disc and adjacent vertebral osteomyelitis, observed spontaneously or after invasive spinal procedures or surgery (1-3). Magnetic resonance imaging (MRI) is the diagnostic technique of choice, with sensitivity and specificity of 96% and 94%, respectively, whereas radiographic abnormalities only appear several weeks or months after clinical symptoms (4,5).Given the wide spectrum of potential pathogens (Staphylococcus aureus, coagulase-negative staphylococci [CoNS], streptococci, gram-negative bacilli, Mycobacterium species, fungi), definite identification of the microbial agent is mandatory before initiation of longduration and appropriate parenteral antibiotic therapy. In the absence of bacteremia, percutaneous disc aspiration or biopsy is performed for pathogen identification, but conventional microbiologic techniques fail to identify the causative agent in 30-50% of patients (2,6-9).Nonculture molecular methods based on the amplification and/or sequence analysis of conserved or species-specific genomic ...

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Section: Diagnosing Infectious Discitis By Dna Analysissupporting

confidence: 81%

Section: Diagnosing Infectious Discitis By Dna Analysismentioning

confidence: 99%

mentioning

confidence: 99%

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The etiologic diagnosis of infectious discitis is improved by amplification‐based DNA analysis

Lecouvet¹,

Irenge²,

Vandercam³

et al. 2004

Arthritis & Rheumatism

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“…Other reports have found that generally, spinal infections are more commonly localised to the lower thoracic and lumbar spine. 6,9 Buchelt found no statistical di erence in the level of involvement between those with tuberculous and pyogenic spondylitis.…”

Section: Discussionmentioning

confidence: 93%

“…This was also comparable with the rates (10 ± 42%) reported in other series. 6,9 Recent studies have attributed a rising incidence of spinal infection to increasing intravenous drug abuse. 2,3,5,7,10,12 Interestingly, none of our patients belonged to this high risk group.…”

Section: Discussionmentioning

confidence: 99%

Infectious disease of the spine: outcome of rehabilitation

1998

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Infectious disease of the spine is infrequently seen in the rehabilitation setting. We examined retrospectively 26 patients with spinal infections admitted to the rehabilitation centre over a 6-year period to determine the demographic characteristics, clinical features and outcome after rehabilitation.Their ages ranged from 24 to 83 years (mean=56.4); 65.4% were males. The infection was due to pyogenic bacteria in 14 patients (53.8%) and Mycobacterium tuberculosis in 12 (46.2%). Staphylococcus aureus was the causative agent in 69% of those with pyogenic infections. A history of diabetes mellitus was present in 35.7% of the pyogenic group but in only 8.3% of the tuberculous group. Localised back pain, fever and neurological de®cits were the typical clinical manifestations. The most common site of infection was the thoracic region. Surgery was performed on 24 patients and all received prolonged courses of antibiotics.All but three patients completed the rehabilitation programme. The motor score for the lower limbs and the modi®ed Barthel scores for activities of daily living (ADL) and mobility improved signi®cantly (P50.05) for both pyogenic and tuberculous groups. The amounts of improvement achieved were not signi®cantly di erent between the pyogenic and tuberculous groups except for ADL. Age, gender and the presence of diabetes mellitus did not appear to signi®cantly a ect the neurological or functional outcome in our study population. The majority of patients (87.5%) were discharged to their own homes.

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