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

Abstract

Previously, the simultaneous presence of endocarditis (IE) has been reported in 3–30% of spondylodiscitis cases. The specific implications on therapy and outcome of a simultaneous presence of both diseases are not yet fully evaluated. Therefore, the aim of this study was to investigate the influence of a simultaneously present endocarditis on the course of therapy and outcome of spondylodiscitis. A prospective database analysis of 328 patients diagnosed with spontaneous spondylodiscitis (S) using statistical analysis with propensity score matching was conducted. Thirty-six patients (11.0%) were diagnosed with concurrent endocarditis (SIE) by means of transoesophageal echocardiography. In our cohort, the average age was 65.82 ± 4.12 years and 64.9% of patients were male. The incidence of prior cardiac or renal disease was significantly higher in the SIE group (coronary heart disease SIE n = 13/36 vs. S n = 57/292, p < 0.05 and chronic heart failure n = 11/36 vs. S n = 41/292, p < 0.05, chronic renal failure SIE n = 14/36 vs. S n = 55/292, p < 0.05). Complex interdisciplinary coordination and diagnostics lead to a significant delay in surgical intervention (S = 4.5 ± 4.5 days vs. SIE = 8.9 ± 9.5 days, p < 0.05). Mortality did not show statistically significant differences: S (13.4%) and SIE (19.1%). Time to diagnosis and treatment is a key to efficient treatment and patient safety. In order to counteract delayed therapy, we developed a novel therapy algorithm based on the analysis of treatment processes of the SIE group. We propose a clear therapy pathway to avoid frequently observed pitfalls and delays in diagnosis to improve patient care and outcome.

The Hamburg Spondylodiscitis Assessment Score (HSAS) for Immediate Evaluation of Mortality Risk on Hospital Admission

“…To screen for endocarditis, all patients routinely underwent transthoracic echocardiography (TTE). When TTE proved inconclusive, transesophageal echocardiography was performed by a board-certified cardiologist [13]. Each patient was discussed at a weekly interdisciplinary infectious disease conference where the course of treatment, duration of intravenous antibiotic treatment or switch to oral antibiotic treatment was determined individually [18].…”

“…Known risk factors associated with an increased mortality of S include advanced age, intravenous drug abuse, infective endocarditis, degenerative spine disease, prior (spinal) surgery, liver cirrhosis, malignancies, hemodialysis, diabetes mellitus, corticosteroid therapy and other immunocompromised states [2,7,11,13]. Despite adequate treatment, sequelae resulting from chronic pain and persistent disability are high, with less than one-third of all patients achieving full recovery [5,7,10].…”

Prevalence of Infective Endocarditis among Patients with Staphylococcus aureus Bacteraemia and Bone and Joint Infections

“…Although the link between IE and BJI is acknowledged, certain questions remain unresolved [ 10 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. Most studies have focused primarily on NBJI, particularly in cases of vertebral osteomyelitis [ 25 , 26 , 27 , 28 , 31 ].…”

“…Although the link between IE and BJI is acknowledged, certain questions remain unresolved [ 10 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. Most studies have focused primarily on NBJI, particularly in cases of vertebral osteomyelitis [ 25 , 26 , 27 , 28 , 31 ]. Additionally, there is a scarcity of data concerning the impact of multiple BJIs [ 10 ], contiguous BJI [ 10 ], and the timing of local symptoms onset on the risk of developing IE [ 33 ].…”

Infektionen der Wirbelsäule

“…PR A XIS Tipp Falls sich eine Spondylodiszitis mit begleitender Endokarditis zeigt, halten es die Autoren für sinnvoll, bei chirurgischer Therapieindikation der Spondylodiszitis und kardial kompensiertem Patienten zunächst die Wirbelsäule zu sanieren, um eine Reinfektion einer möglichen neuen Herzklappe zu vermeiden. Im Falle kardial dekompensierter Patienten und der Notwendigkeit einer vorrangigen Klappenoperation sollte im Anschluss aus demselben Grund zeitnah eine chirurgische Sanierung der Spondylodiszitis erfolgen [21].…”