Background
Methods
Study design and patient data
Clinico-microbiological management
Diagnosis and treatment
Microbiological assessment
Blood culture
Tissue from CT-guided or intraoperative sampling
Antimicrobial susceptibility
Formation of groups
Statistical analysis
Results
Demographics and baseline characteristics
Baseline characteristics | N = 187 | Percentage |
---|---|---|
Male | 120 | 64.2% |
Female | 67 | 35.8% |
Age | 68 [23–90] y* | – |
Spondylodiscitis | 125 | 66.8% |
Isolated spinal epidural empyema | 62 | 33.2% |
Gram-positive bacteria | 162/187 | 86.6% |
Gram-negative bacteria | 25/187 | 13.4% |
Surgery | 187 | 100% |
Blood cultures | 187 | 100% |
Psoas abscess | 116 | 62.0% |
CT-guided biopsy of Psoas | 65/116 | 56.0% |
Empiric antibiotic therapy (EAT) | 122 | 65.2% |
Targeted antibiotic therapy (TAT) | 65 | 34.8% |
Duration of intravenous antibiotics | 4 [3–6] w* | – |
Duration of total antibiotics | 8 [6–12] w* | – |
Sepsis | 94/187 | 50.3% |
Septic embolism | 50/150 | 33.3% |
Infective endocarditis with vegetation in TTE/TEE | 23/161 | 14.3% |
Relapse rate (clinical, microbiological, and/or radiological progression) | 28/123 | 22.8% |
Disease-related mortality | 10/187 | 5.3% |
Identified bacteria
Gram spectrum of bacteria
Entities, complications, and primary source of infection (n = 187) | Gram-positive bacteria (n = 162, 86.6%) | Gram-negative bacteria (n = 25, 13.4%) | p-value* |
---|---|---|---|
SD | 105/162 (64.8%) | 20/25 (80.0%) | 0.172 |
ISEE | 57/162 (35.2%) | 5/25 (20.0%) | |
Sepsis | 81/162 (50.0%) | 13/25 (52.0%) | 1.0 |
Septic embolism | 46/128 (35.9%) | 4/22 (18.2%) | 0.142 |
Endocarditis | 23/139 (16.5%) | 0/22 (0.0%) | 0.046 |
Relapse rate | 22/103 (21.4%) | 6/20 (30.0%) | 0.394 |
Disease-related mortality | 9 (5.6%) | 1 (4.0%) | 1.0 |
Source of infection (129/187, 69.0%) | |||
Hematogenous spread | < 0.001(1) | ||
Gastrointestinal tract infection | 6/107 (5.6%) | 3/22 (13.6) | |
Respiratory tract infection (pneumonia) | 15/107 (14.0%) | 1/22 (4.5%) | |
Urinary tract infection (urosepsis) | 4/107 (3.7%) | 9/22 (40.9%) | |
Skin infection | 34/107 (31.8%) | 3/22 (13.6%) | |
Foreign body-associated infection (joint replacements, venous access port, prosthetic heart valve, and screws elsewhere in spine) | 20/108 (18.7%) | 3/22 (13.6%) | |
Odontogenic infection | 5/107 (4.7%) | 0/22 (0.0%) | |
Retropharyngeal & prevertebral infection | 4/107 (3.7) | 2/22 (9.1%) | |
Post-interventional | |||
Epidural administration such as spinal infiltration (facet joint, epidural, periradicular) or epidural catheter analgesia | 19/107 (17.8%) | 1/22 (4.5%) |
Subgroups
Methicillin-susceptible Staphylococcus aureus (MSSA)
Total n = 187 | MSSA (100, 53.5%) | Other bacteria (87, 46.5%) | p-value |
---|---|---|---|
Sex | M: 63 (63.0%) F: 37 (37.0%) | M:57 (65.5%) F: 30 (34.5%) | 0.761(2) |
Age | 67 [23–90] y | 72 [47–89] y | 0.052(3) |
Spondylodiscitis | 57 (57.0%) | 68 (78.2%) | 0.003(2) |
Isolated spinal epidural empyema | 43 (43.0%) | 19 (21.8%) | |
Sepsis | 56/100 (56.0%) | 38/87 (43.7%) | 0.108(2) |
Septic embolism | 29/79 (36.7%) | 21/71 (29.6%) | 0.389(2) |
Endocarditis | 13/86 (15.1%) | 10/75 (13.3%) | 0.824(2) |
Relapse rate | 10/64 (15.6%) | 18/59 (30.5%) | 0.056(2) |
Disease-related mortality | 6/100 (6.0%) | 4/87 (4.6%) | 0.753(2) |
Length of hospital stay | 31 [9-163] d | 35 [10–165] | 0.182(3) |
Length of intensive care unit stay | 8 [1–53] d | 4 [1–46] d | 0.093(3) |
Spinal localization | |||
Cervical spine | 41 (41.0%) | 18 (20.7%) | 0.004(2) |
Thoracic spine | 45 (45.0%) | 30 (34.5%) | 0.178(2) |
Lumbar spine | 64 (64.0%) | 59 (67.8%) | 0.644(2) |
Bacterial detection via | |||
Blood cultures | 67 (67.0%) | 51 (58.6%) | 0.288(2) |
Intraoperative specimens | 87 (87.0%) | 70 (80.5%) | 0.238(2) |
CT-guided biopsies (37/65) | 23/41 (56.1%) | 14/24 (58.3%) | 1.0(2) |
Source of infection (129/187, 69.0%) | |||
Hematogenous spread | < 0.001(1) | ||
Gastrointestinal tract infection | 2/63 (3.2%) | 7/66 (10.6%) | |
Respiratory tract infection (pneumonia) | 9/63 (14.3%) | 7/66 (10.6%) | |
Urinary tract infection (urosepsis) | 3/63 (4.8%) | 10/66 (15.2%) | |
Skin infection | 26/63 (41.3%) | 11/66 (16.7%) | |
Foreign body-associated infection (joint replacements, venous access port, prosthetic heart valve, and screws elsewhere in spine) | 5/63 (7.9%) | 18/66 (27.3%) | |
Odontogenic infection | 4/63 (6.3%) | 1/66 (1.5%) | |
Retropharyngeal & prevertebral infection | 2/63 (3.2%) | 4/66 (6.1%) | |
Post-interventional | |||
Epidural administration such as spinal infiltration (facet joint, epidural, periradicular) or epidural catheter analgesia | 12/63 (19.0%) | 8/66 (12.1%) |
Streptococcus spp. and Enterococcus spp. (SE)
Total n = 187 | Streptococci & Enterococci (31, 16.6%) | Other bacteria (156, 83.4%) | p-value |
---|---|---|---|
Sex | M: 21 (67.7%) F: 10 (32.3%) | M: 99 (63.5%) F: 57 (36.5%) | 0.688(2) |
Age | 72 [48–89] y | 67 [23–90] y | 0.190(3) |
Spondylodiscitis | 26 (83.9%) | 99 (63.5%) | 0.036(2) |
Isolated spinal epidural empyema | 5 (16.1%) | 57 (36.5%) | |
Sepsis | 16/31 (51.6%) | 78/156 (50.0%) | 1.0(2) |
Septic embolism | 12/27 (44.4%) | 38/123 (30.9%) | 0.184(2) |
Endocarditis | 8/29 (27.6%) | 15/132 (11.4%) | 0.037(2) |
Relapse rate | 6/17 (35.3%) | 22/106 (20.8%) | 0.215(2) |
Disease-related mortality | 3/31 (9.7%) | 7/156 (4.5%) | 0.218(2) |
Length of hospital stay | 38 [10–165] d | 32 [9-163] d | 0.289(3) |
Length of intensive care unit stay | 7 [1–46] d | 6 [1–53] d | 0.944(3) |
Spinal localization | |||
Cervical spine | 23 (74.2%) | 95 (60.9%) | 0.221(2) |
Thoracic spine | 13 (42.0%) | 62 (39.7%) | 0.843(2) |
Lumbar spine | 25 (80.6%) | 98 (62.8%) | 0.064(2) |
Bacterial detection via | |||
Blood cultures | 23 (74.2%) | 95 (60.9%) | 0.221(2) |
Intraoperative specimens | 19 (61.3%) | 138 (88.5%) | < 0.001(2) |
CT-guided biopsies (37/65) | 7/11 (63.6%) | 30/54 (55.6%) | 0.745(2) |
Source of infection (129/187, 69.0%) | |||
Hematogenous spread | 0.344(1) | ||
Gastrointestinal tract infection | 3/24 (12.5%) | 6/105 (5.7%) | |
Respiratory tract infection (pneumonia) | 4/24 (16.7%) | 12/105 (11.4%) | |
Urinary tract infection (urosepsis) | 0/24 (0.0%) | 13/105 (12.4%) | |
Skin infection | 5/24 (20.8%) | 32/105 (30.5%) | |
Foreign body-associated infection (joint replacements, venous access port, prosthetic heart valve, and screws elsewhere in spine) | 6/24 (25.0%) | 17/105 (16.2%) | |
Odontogenic infection | 0/24 (0.0%) | 5/105 (4.8%) | |
Retropharyngeal & prevertebral infection | 1/24 (4.2%) | 5/105 (4.8%) | |
Post-interventional | |||
Epidural administration such as spinal infiltration (facet joint, epidural, periradicular) or epidural catheter analgesia | 5/24 (20.8%) | 15/105 (14.3%) |
Enterobacterales (E)
Total n = 187 | Enterobacterales (20, 10.7%) | Other bacteria (167, 89.3%) | p-value |
---|---|---|---|
Sex | M: 12 (60.0%) F: 8 (40.0%) | M: 108 (64.7%) F: 59 (35.3%) | 0.806(2) |
Age | 72 [54–83] y | 68 [23–90] y | 0.543(3) |
Spondylodiscitis | 16 (80.0%) | 109 (65.3%) | 0.218(2) |
Isolated spinal epidural empyema | 4 (20.0%) | 58 (34.7%) | |
Sepsis | 10/20 (50.0%) | 84/167 (50.3%) | 1.0(2) |
Septic embolism | 3/19 (15.8%) | 47/131 (35.9%) | 0.117(2) |
Endocarditis | 0/18 (0.0%) | 23/143 (16.1%) | 0.078(2) |
Relapse rate | 6/17 (35.3%) | 22/106 (20.8%) | 0.215(2) |
Disease-related mortality | 1/20 (5.0%) | 9/167 (5.4%) | 1.0(2) |
Length of hospital stay | 33 [15–70] d | 32 [9-165] d | 0.629(3) |
Length of intensive care unit stay | 4 [1–17] d | 7 [1–53] d | 0.093(3) |
Spinal localization | |||
Cervical spine | 5 (25.0%) | 54 (32.3%) | 0.616(2) |
Thoracic spine | 5 (25.0%) | 70 (41.9%) | 0.227(2) |
Lumbar spine | 14 (70.0%) | 109 (65.3%) | 0.805(2) |
Bacterial detection via | |||
Blood cultures | 12 (60.0%) | 106 (63.5%) | 0.809(2) |
Intraoperative specimens | 16 (80.0%) | 141 (84.4%) | 0.535(2) |
CT-guided biopsies (37/65) | 1/4 (25.0%) | 36/61 (59.0%) | 0.307(2) |
Source of infection (129/187, 69.0%) | |||
Hematogenous spread | < 0.001(1) | ||
Gastrointestinal tract infection | 3/18 (16.7%) | 6/111 (5.4%) | |
Respiratory tract infection (pneumonia) | 0/18 (0.0%) | 16/111 (14.4%) | |
Urinary tract infection (urosepsis) | 9/18 (50.0%) | 4/111 (3.6%) | |
Skin infection | 3/18 (16.7%) | 34/111 (30.6%) | |
Foreign body-associated infection (joint replacements, venous access port, prosthetic heart valve, and screws elsewhere in spine) | 2/18 (11.1%) | 21/111 (18.9%) | |
Odontogenic infection | 0/18 (0.0%) | 5/111 (4.5%) | |
Retropharyngeal & prevertebral infection | 1/18 (5.6%) | 5/111 (4.5%) | |
Post-interventional | |||
Epidural administration such as spinal infiltration (facet joint, epidural, periradicular) or epidural catheter analgesia | 0/18 (0.0%) | 20/111 (18.0%) |
Coagulase-negative Staphylococci (CoNS)
Total n = 187 | Coagulase-neg. Staphylococci (20, 10.7%) | Other bacteria (167, 89.3%) | p-value |
---|---|---|---|
Sex | M:14 (70.0%) F: 6 (30.0%) | M: 106 (63.5%) F: 61 (36.5%) | 0.630(2) |
Age | 67 [47–82] y | 69 [23–90] y | 0.839(3) |
Spondylodiscitis | 15 (75.0%) | 110 (65.9%) | 0.464(2) |
Isolated spinal epidural empyema | 5 (25.0%) | 57 (34.1%) | |
Sepsis | 4/20 (20.0%) | 90/167 (53.9%) | 0.004(2) |
Septic embolism | 3/15 (20.0%) | 47/135 (34.8%) | 0.387(2) |
Endocarditis | 2/16 (12.5%) | 21/145 (14.5%) | 1.0(2) |
Relapse rate | 3/16 (18.8%) | 25/107 (23.4%) | 1.0(2) |
Disease-related mortality | 0/20 (0.0%) | 10/167 (6.0%) | 0.604(2) |
Length of hospital stay | 34 [17–135] d | 32 [9-165] d | 0.381(3) |
Length of intensive care unit stay | 6 [1–53] d | 0.037(3) | |
Spinal localization | |||
Cervical spine | 3 (15.0%) | 56 (33.5%) | 0.126(2) |
Thoracic spine | 7 (35.0%) | 68 (40.7%) | 0.810(2) |
Lumbar spine | 15 (75.0%) | 108 (64.7%) | 0.458(2) |
Bacterial detection via | |||
Blood cultures | 9 (45.0%) | 109 (65.3%) | 0.089(2) |
Intraoperative specimens | 20 (100.0%) | 137 (82.0%) | 0.048(2) |
CT-guided biopsies (37/65) | 2/3 (66.7%) | 35/62 (56.5%) | 1.0(2) |
Source of infection (129/187, 69.0%) | |||
Hematogenous spread | 0.005(1) | ||
Gastrointestinal tract infection | 0/13 (0.0%) | 9/116 (7.8%) | |
Respiratory tract infection (pneumonia) | 1/13 (7.7%) | 15/116 (12.9%) | |
Urinary tract infection (urosepsis) | 1/13 (7.7%) | 12/116 (10.3%) | |
Skin infection | 1/13 (7.7%) | 36/116 (31.0%) | |
Foreign body-associated infection (joint replacements, venous access port, prosthetic heart valve, and screws elsewhere in spine) | 8/13 (61.5%) | 15/116 (12.9%) | |
Odontogenic infection | 0/13 (0.0%) | 5/116 (4.3%) | |
Retropharyngeal & prevertebral infection | 0/13 (0.0%) | 6/116 (5.2%) | |
Post-interventional | |||
Epidural administration such as spinal infiltration (facet joint, epidural, periradicular) or epidural catheter analgesia | 2/13 (15.4%) | 18/116 (15.5%) |