Pyogenic vertebral osteomyelitis of the elderly: Characteristics and outcomes

Courjon, Johan; Lemaignen, Adrien; Ghout, Idir; Therby, A.; Belmatoug, Nadia; Dinh, Aurélien; Gras, Guillaume; Bernard, Louis

doi:10.1371/journal.pone.0188470

Cited by 44 publications

(37 citation statements)

References 19 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, there is contradictory evidence about age as a prognostic factor. The post-hoc analysis of the Duration of Treatment for Spondylodiscitis (DTS) study examining 351 patients showed higher rates of severe adverse events in the ≥ 75-year-old group (45.9% vs 23.3%, p < 0.001) regardless of the severity of neurological complications or time to treatment initiation [14]. In this study, older patients were more likely to have neoplasia and chronic inflammatory diseases.…”

Section: Discussionmentioning

confidence: 58%

Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years’ intensive care experience

Milošević¹,

Çevik

Urošević³

et al. 2020

J Infect Dev Ctries

View full text Add to dashboard Cite

Introduction: Management of pyogenic spinal infections (PSI) after the development of neurological deficit has not been specifically addressed in the literature. We aimed to describe real-life clinical outcomes of PSI in patients admitted to an intensive care unit with neurological deficit and identify factors associated with good prognosis. Methodology: Consecutive patients admitted to ICU with a possible diagnosis of spinal infection over five years’ period were included. Descriptive statistics were performed to examine the demographics and clinical parameters. Results: The majority (71%) of patients were male. The mean age was 57.4 years (27-79), and 71% were > 50 years old. At least one underlying risk factor was identified in 68% of the patients; the most common comorbidity was diabetes mellitus (DM). All patients have presented with fever accompanied by a neurological deficit (86%) and back pain (79%). A complete recovery was achieved in 25% of patients. However, the majority of patients had adverse outcomes with 21.4% mortality, and 43% remaining neurological sequelae. Increased age with a cut-off of 65 years and pre-existing DM were identified as being associated with poor outcome. Conclusion: Mortality among patients admitted to ICU with PSI was significantly higher than reported in the literature. The residual neurological deficit was common, one-third of patients had remaining neurological sequelae, and only one-fourth had complete recovery. Increased age and background DM were the most important determinants of poor clinical outcome. The impact of DM appears to be much more important than currently recognised in this population.

show abstract

Section: Discussionmentioning

confidence: 58%

Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years’ intensive care experience

Milošević¹,

Çevik

Urošević³

et al. 2020

J Infect Dev Ctries

View full text Add to dashboard Cite

show abstract

“…A large cohort study by Issa et al [1] reported an early (in-hospital) mortality rate of 1.7%–2.2%. Loibl et al [8] found a slightly higher in-hospital mortality of 12.4%, and Courjon et al [11] reported 1-year mortality rates at 21% in patients aged >75 years and 3% in those aged <75 years; these data demonstrate the impact of increased age on mortality risk. Also, Courjon et al [11] linked the increased mortality risk in the elderly with a greater prevalence of neoplasia in that specific cohort.…”

Section: Discussionmentioning

confidence: 96%

“…Loibl et al [8] found a slightly higher in-hospital mortality of 12.4%, and Courjon et al [11] reported 1-year mortality rates at 21% in patients aged >75 years and 3% in those aged <75 years; these data demonstrate the impact of increased age on mortality risk. Also, Courjon et al [11] linked the increased mortality risk in the elderly with a greater prevalence of neoplasia in that specific cohort. We did not replicate this finding, but we did observe that CRF, frailty, and disease severity (indicated by number of involved vertebral levels) were associated with an increased risk of mortality, consistent with previous reports [11,12].…”

Section: Discussionmentioning

confidence: 96%

Pyogenic Vertebral Column Osteomyelitis in Adults: Analysis of Risk Factors for 30-Day and 1-Year Mortality in a Single Center Cohort Study

et al. 2019

View full text Add to dashboard Cite

Study Design Retrospective cohort study. Purpose To describe our experience in the management and outcomes of vertebral column osteomyelitis (VCO), particularly focusing on the risk factors of early and late mortality. Overview of Literature Previous reports suggest a global increase in spinal column infections highlighting significant morbidity and mortality. To date, there have been no reports from our local population, and no previous report has assessed the potential relationship of frailty with mortality in a cohort of patients with VCO. Methods We reviewed 76 consecutive patients with VCO between 2009 and 2016 in Waikato Hospital, New Zealand. Demographic, clinical, microbiological, and treatment data were collected. Comorbidities were noted to calculate the modified Frailty Index (mFI). Mortality at 30 days and 1 year was recorded. Univariate and multivariate analyses were used to identify the predictors of mortality. Results The mean age of patients was 64.1 years, with 77.6% being male. Most patients presented with axial back pain (71.1%), with the lumbar spine most commonly affected (46%). A mean of 2.1 vertebral bodies was involved. Methicillin-sensitive Staphylococcus aureus was the most common organism of infection (35.5%), and 15.8% of patients exhibited polymicrobial infection. Twenty patients (26.3%) underwent surgical intervention, which was more likely in patients with concomitant spinal epidural abscess (odds ratio [OR], 4.88) or spondylodiscitis (OR, 3.81). Mortality rate was 5.2% at 30 days and 22.3% at 1 year. The presence of frailty (OR, 13.62) and chronic renal failure (OR, 13.40) elevated the 30-day mortality risk only in univariate analysis. An increase in age (OR, 1.07) and the number of vertebral levels (OR, 2.30) elevated the 1-year mortality risk in both univariate and multivariate analyses. Conclusions Although the mFI correlated with 30-day mortality in univariate analysis, it was not a significant predictor in multivariate analysis. An increase in age and the number of levels involved elevated the 1-year mortality risk.

show abstract

“…Among primary SEA, a further distinction can be made between SEAs that are associated with pyogenic infectious spondylodiscitis (PS) and SEAs that, at least at the time of the diagnosis, are not associated with neuroradiological signs of infection of the vertebrae and/or the corresponding disks (14). Approximately 37% of patients affected by PS will develop an epidural abscess (15), and this rate is not affected by aging (16). Primary SEAs not associated with PS account (14,17) and are usually considered as due to the hematogenous spread of circulating bacteria or fungi into the epidural space (12).…”

Section: Introductionmentioning

confidence: 99%

Primary Spinal Epidural Abscesses Not Associated With Pyogenic Infectious Spondylodiscitis: A New Pathogenetic Hypothesis

et al. 2020

View full text Add to dashboard Cite

Spinal epidural abscess (SEA) incidence is rising. However, most series do not differentiate between SEAs associated with pyogenic infectious spondylodiscitis (PS) and SEAs limited to the epidural space. Methods: We retrospectively reviewed the records and radiological images of all patients admitted to our institutions with a diagnosis of SEA not associated with PS between January 2013 and December 2018. Results: We found three males and four females; five of the seven were intravenous drug users. All patients presented with pain: in six, it was associated with acute motor and sensory deficits, while one had only pain and paresthesias. Staphylococcus aureus was cultured from abscesses and/or from multiple blood cultures in four patients. Abscesses were localized to the cervical spine in one patient, thoracic in three, lumbar in one, and in two, the SEAs involved multiple segments. All patients but one underwent urgent open surgery. This patient had a multisegmental abscess and was successfully treated by percutaneous aspiration when pain became intractable. After abscess evacuation, the neurological deficits improved in all patients except one. The patients that were treated without spine instrumentation did not develop delayed kyphosis or instability at follow-up. Conclusion: Patients with SEAs not associated with PS are likely to present with pain and motor deficits, appear to benefit from urgent abscess evacuation, and seem to be less dependent on spine instrumentation to avoid delayed spinal deformities compared to SEA associated with PS. Finally, the lack of initial involvement of bone and intervertebral disks may suggest that at least some of the SEAs without PS originate from infection of epidural lymphatic vessels that are not present inside those structures.

show abstract

Pyogenic vertebral osteomyelitis of the elderly: Characteristics and outcomes

Cited by 44 publications

References 19 publications

Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years’ intensive care experience

Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years’ intensive care experience

Pyogenic Vertebral Column Osteomyelitis in Adults: Analysis of Risk Factors for 30-Day and 1-Year Mortality in a Single Center Cohort Study

Primary Spinal Epidural Abscesses Not Associated With Pyogenic Infectious Spondylodiscitis: A New Pathogenetic Hypothesis

Contact Info

Product

Resources

About