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Background: Vertebral Osteomyelitis (VO) is an infectious disease that could involve intervertebral space (discitis). Its incidence is raising for several reasons, such as the increasing number of patients on immunosuppressive therapy. The treatment includes long term antibiotic, that should be initiated after biopsy (if possible) and sometimes, further surgery is needed1. Objectives: To analyze the influence on prognosis of detection of OV in immunosuppressed (IS) patients. Methods: Single center retrospective observational study including IS adult patients diagnosed of VO based on the combination of clinical presentation with either a definitive bacteriologic diagnosis or pathological and/or imaging studies from January 2010 to January 2019. Demographic features, concurrent diseases, clinical history (length of pain and fever prior to admission), laboratory findings, microbiological diagnosis and radiological data were compiled. We considered as IS patients those who had rheumatic or inflammatory bowel disease undertaking immunomodulatory drugs, solid organ transplantation receptors, patients with an active malignancy or Human Immunodeficiency Virus (HIV) infected. Clinical and radiological history of lumbar stenosis or disc herniation was considered as prior spine pathology. Surgical infections were excluded. We considered deaths attributive to PVO those which were directly caused by the infectious picture and/or its complications during the next year after diagnosis. Results: Eighteen of 122 patients with VO (21.96%) were IS. Basal demographic and clinical features are exposed in table 1. Detailed data about the cause of the IS is provided separately in table 2. Duration of pain prior to diagnosis had a median of 30 days (15.5, 55). C reactive protein showed a median value of 65.2mg/L (19.32, 153.9) and Erythrocyte Sedimentation Rate mean value was 80.57mm/H (31.75). MRI was the imaging technique most often used for diagnosis (83.33%), followed by CT-scan(16.67%). The region most frequently affected was lumbosacral spine (44.44), then dorsal (33.33%) and finally cervical (22.22%). Some abscess (epidural or paravertebral) was detected in 16 patients (88.89%) close to non-IS patients (90.38%). Worst data concerning vertebral destruction was observed (66.67% in IS group against 49.04 in non-IS, p=0.3) and cord compression (61.11% versus 26.92% respectively, p=0.05). Fifteen patients underwent CT guided biopsy (83.33%) with prior antibiotic exposure in 11 of them. Median exposure was 4.5 days (3, 8.75). Delay from admission to procedure had a median value of 6 days (3.5, 9). Culture was positive in 53.33% of cases. In 10 patients, the picture was attributed to Gram+ (55.56%), in other 2 cases Gram- (11.11) and 1 case of tuberculosis (5.56). In 5 cases (27.78%) final pathogen was unknown. Four patients (22.22%) required further surgery and 2 patients (11.11) died, similar than non-IS group, 11.54%. Conclusion: In general terms, data about imaging is worse in IS patients and higher proportion of cervical spine involvement was also noted. Although, early intervention (diagnosis, punction guided biopsy and treatment) seems to be protective against a bad outcome, since IS patients showed similar prognosis (further surgical procedures and death) than non IS patients. To sum up, new onset back pain in a IS patient, should be thoroughly studied so as to consider a VO as soon as possible. Disclosure of Interests: None declared |
