Spondylodiscitis complicating infective endocarditis

Abstract

ObjectiveThe primary objective was to assess the characteristics and prognosis of pyogenic spondylodiscitis (PS) in patients with infective endocarditis (IE). The secondary objectives were to assess the factors associated with occurrence of PS.MethodsProspective case–control bi-centre study of 1755 patients with definite IE with (n=150) or without (n=1605) PS. Clinical, microbiological and prognostic variables were recorded.ResultsPatients with PS were older (mean age 69.7±18 vs 66.2±14; p=0.004) and had more arterial hypertension (48% vs 34.5%; p<0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without PS. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L4–L5. Neurological symptoms were observed in 59% of patients. Enterococci and Streptococcus gallolyticus were more frequent (24% vs 12% and 24% vs 11%; p<0001, respectively) in the PS group. The diagnosis of PS was based on contrast-enhanced MRI in 92 patients, bone CT in 88 patients and 18F-FDG PET/CT in 56 patients. In-hospital (16% vs 13.5%, p=0.38) and 1-year (21% vs 22%, p=0.82) mortalities did not differ between patients with or without PS.ConclusionsPS is a frequent complication of IE (8.5% of IE), is observed in older hypertensive patients with enterococcal or S. gallolyticus IE, and has a similar prognosis than other forms of IE. Since PS is associated with specific management, multimodality imaging including MRI, CT and PET/CT should be used for early diagnosis of this complication of endocarditis.

Spontaneous spondylodiscitis and endocarditis: interdisciplinary experience from a tertiary institutional case series and proposal of a treatment algorithm

“…As previously described by various authors, there is a predominance of the male sex in both the S and SIE group [6,8,9,27]. Age and gender distribution in our collective was similar to those of other large spondylodiscitis [10] and endocarditis [6] collectives. Patients with IE showed typical distributions of affected valves [26].…”

“…Patients with known IE presenting with even mild symptoms of back pain should undergo an in-depth diagnostic workup using MRI (magnetic resonance imaging) to avoid missed or delayed diagnosis of spondylodiscitis [6]. Especially in an older population, delayed diagnosis of spondylodiscitis is associated with increased morbidity and mortality rates of up to 27% [6,[9][10][11][12].…”

“…Even though previous retrospective studies analyzed specific indications and corresponding outcome, there is still no gold standard regarding therapy pathways [ 28 ]. It has previously been reported that a concomitant infective endocarditis (SIE) is present in up to 30% of spondylodiscitis cases [ 3 , 6 , 7 , 24 ]. Endocarditis (IE), like spondylodiscitis, is a life-threatening disease with a mortality rate of up to 30% [ 14 , 23 , 29 ] and also shows an increasing incidence due to demographic changes [ 9 ].…”

“…The simultaneous occurrence of such serious diseases has rarely been described and analyzed previously. Also, the frequency of IE in spondylodiscitis cohorts has not yet been sufficiently investigated and reported rates differ greatly from 4–10% [ 6 , 24 ] to 30% [ 3 ]. Confirmation of diagnosis is greatly influenced by the screening method used [ 3 , 24 ].…”

El peligro de los comensales: endocarditis complicada con espondilodiscitis por Staphylococcus capitis

“…La espondilodiscitis consiste en la inflamación de los cuerpos vertebrales y/o del disco intervertebral. Como complicación reumatológica de una endocarditis, la espondilodiscitis es una entidad históricamente rara, aunque algunos estudios recientes indiquen un aumento de su prevalencia 1 . Parece asociarse a embolización sistémica, sobre todo en pacientes con afectación de la válvula mitral, y se ha relacionado con una mayor morbilidad.…”