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Pyogenic Spondylodiscitis: Risk Factors for Adverse Clinical Outcome in Routine Clinical Practice

Lookup NU author(s): Dr John Widdrington, Ingrid Emmerson, Dr Edmund Ong, Dr Matthias Schmid, Dr David Price, Dr Ulrich Schwab, Dr Christopher DuncanORCiD

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Abstract

We aimed to describe the clinical features and outcomes of pyogenic spondylodiscitis and to identify factors associated with an unfavourable clinical outcome (defined as death, permanent disability, spinal instability or persistent pain). In our tertiary centre, 91 cases were identified prospectively and a retrospective descriptive analysis of clinical records was performed prior to binary regression analysis of factors associated with an unfavourable outcome. A median 26 days elapsed from the onset of symptoms to diagnosis and 51% of patients had neurological impairment at presentation. A microbiological diagnosis was reached in 81%, with Staphylococcus aureus most commonly isolated. Treatment involved prolonged hospitalisation (median stay 40.5 days), long courses of antibiotics (>6 weeks in 98%) and surgery in 42%. While this was successful in eradicating infection, only 32% of patients had a favourable clinical outcome and six patients (7%) died. Diabetes mellitus, clinical evidence of neurological impairment at presentation, a longer duration of symptoms and radiological evidence of spinal cord or cauda equina compression were independent factors associated with an unfavourable outcome. Our data indicate that spondylodiscitis is associated with significant morbidity and suggest that adverse outcomes may be predicted to an extent by factors present at the time of diagnosis.

Publication metadata

Author(s): Widdrington JD, Emmerson I, Cullinan M, Narayanan M, Klejnow E, Watson A, Ong ELC, Schmid ML, Price DA, Schwab U, Duncan CJA

Publication type: Article

Publication status: Published

Journal: Medical Sciences

Year: 2018

Volume: 6

Issue: 4

Pages: 96

Print publication date: 30/10/2018

Online publication date: 30/10/2018

Acceptance date: 23/10/2018

Date deposited: 05/03/2019

ISSN (electronic): 2076-3271

Publisher: MDPI

URL: https://doi.org/10.3390/medsci6040096

DOI: 10.3390/medsci6040096

PubMed id: 30380776

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