Infectious spondylitis in the Balearic Islands: An analysis of 51 cases

M Raya Cruz; H H Vilchez Rueda; C I Marinescu; H Sarasíbar Ezcurra; M Riera Jaume; A Payeras Cifre

doi:10.1016/j.rce.2015.01.012

Infectious spondylitis in the Balearic Islands: An analysis of 51 cases

Rev Clin Esp (Barc). 2015 Jun-Jul;215(5):251-7. doi: 10.1016/j.rce.2015.01.012. Epub 2015 Mar 5.

[Article in English, Spanish]

Authors

M Raya Cruz¹, H H Vilchez Rueda², C I Marinescu², H Sarasíbar Ezcurra³, M Riera Jaume², A Payeras Cifre⁴

Affiliations

¹ Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital Son Llàtzer, Palma de Mallorca, España. Electronic address: manuelraya@hotmail.com.
² Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital Son Espases, Palma de Mallorca, España.
³ Servicio de Radiodiagnóstico, Hospital Son Llàtzer, Palma de Mallorca, España.
⁴ Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital Son Llàtzer, Palma de Mallorca, España.

PMID: 25746466
DOI: 10.1016/j.rce.2015.01.012

Abstract

Introduction: Vertebral osteomyelitis (VO) is a rare entity, although its incidence has increased in recent years. The objective is to describe the patients with this infection in our environment and a comparison with other published series.

Methods: A retrospective review was conducted of epidemiological, clinical, microbiological, treatment, complications and evolution data of patients with VO during 10 years (2004-2014) in two hospitals of Mallorca.

Results: 51 cases, median age 66 (range 22-85) years, 37 (72.5%) men with a mean onset of symptoms of 80.1 ± 125.1 days. In thirty-six (70.6%) cases the origin of infection was considered hematogenous, although previous bacteremia was documented in 23 (45%) cases, being of urinary in 10 (43.5%) cases. Clinically at the moment of diagnosis 35 (68.8%) had fever, 32 (62.7%) pain, 14 (27.5%) irradiated nerve pain and 10 (19.6%) paralysis/paresia. MRI was the most performed radiological test 46 (90.2%), being pathological in all cases. S. aureus 23 (52.3%) was the most common microbiological isolates. At the moment of the diagnosis, blood cultures were positive in 27 (65.8%) of 41 cases and 11 (50%) of 22 percutaneous puncture was positive. Paraspinal, epidural or psoas abscesses were observed in 23 (45.1%), neurological deficit in 7 (13.7%) and chronic pain in 6 (11.8%). One patient (1.9%) died in relation with infection.

Conclusions: Diagnosis was delayed in most cases. Previous bacteremia being main predisposing factor and hematogenous origin the main source of infection. S. aureus was the most isolated. Percutaneous puncture together with blood cultures increase etiologic diagnosis. A high percentage of patients had complications or sequelae.

Keywords: Bone diseases; Discitis; Enfermedades óseas; Espondilitis; Infecciosas; Infectious; Osteoarticular tuberculosis; Spinal tuberculosis; Spondylitis; Tuberculosis espinal; Tuberculosis osteoarticular.