Clinical characteristics of pyogenic spondylitis and psoas abscess at a tertiary care hospital: a retrospective cohort study

Abstract

BackgroundPsoas abscess and pyogenic spondylitis are intractable diseases that require long-term treatment, but the clinical characteristics and causative organisms have not been fully investigated. Herein, we describe the clinical characteristics of these diseases and evaluate the factors associated with in-hospital mortality and the presence of gram-negative rods as causative microorganisms.MethodsAll patients diagnosed with pyogenic spondylitis or psoas abscesses at a tertiary hospital were included. We retrieved the clinical data (age, sex, outcome, length of hospital stay, disease, bacteria, medication, comorbidities, and treatment status), vital signs (blood pressure, heart rate, and body temperature), and laboratory test results (blood cell count, liver function, renal function, electrolytes, blood sugar, and C-reactive protein) of all patients. The outcomes were in-hospital deaths and positive cultures of gram-negative rods.ResultsWe analyzed 126 patients consisting of 69 (55%) men with a population mean age of 72 years. Seventy-two patients had pyogenic spondylitis and 54 had psoas abscesses. Eleven patients (8.3%) died during admission. The causative bacteria were gram-positive cocci in 63 patients (50%) and gram-negative bacteria in 19 patients (15%). The multivariate logistic model showed that blood urea nitrogen (BUN) (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02–1.06) and cardiovascular diseases (OR 7.02, 95% CI 1.55–31.8) were associated with in-hospital mortality. Platelets less than 150,000/μL (OR 3.14, 95% CI 1.02–9.65) and higher aspartic aminotransferase (OR 1.02, 95% CI 1.00–1.03) were associated with gram-negative rods.ConclusionsPatients with suspected psoas abscesses or pyogenic spondylitis having a high BUN level and a history of cardiovascular diseases have a higher risk of mortality.

Clinical features, management, and outcome of iliopsoas abscess associated with cardiovascular disorders: a hospital-based observational case series study

“…We found the most common microorganism of blood culture beings Gram-positive cocci (9, 60%), like staphylococci (6, 40%) and streptococci (1, 6.7%). Our results were similar to those by Nakamura et al, who reported Gram-positive cocci (63, 50%) in 126 patients with psoas abscess and pyogenic spondylitis, including staphylococci (51, 40%) and streptococci (8, 6.3%) [10]. For IPA caused by CVD, we recommended here treatment with PCD or surgical drainage and combination with graft replacement to eradicate infection foci.…”

“…Risk factors associated with mortality in IPA caused by CVD were found in our present study to include hypoalbuminemia, hyponatremia, involving disc/vertebral body and/or epidural abscess, and ICU stay with intubation > 3 days. Nakamura et al also reported that the mortality was related to hypotension, hypoalbuminemia, liver failure, and renal dysfunction in patients with psoas abscess and pyogenic spondylitis [10]. Intra-hospital mortality rate was 40% in our present report.…”

“…Intra-hospital mortality rate was 40% in our present report. If patients had cardiovascular disorders, there was a higher risk of mortality in those with psoas abscess or pyogenic spondylitis as reported by Nakamura et al [10]. We reviewed the following scientific reports regarding the anatomy of iliopsoas muscle, clinical etiology, microbiology, management, and outcome of IPA caused by CVD.…”

Epidemiological features and outcomes of patients with psoas abscess: A retrospective cohort study

“…Bony infection accounted for most secondary PA cases in this study. With time, the origin of secondary PA has changed from tuberculosis [ 21 ] and digestive disease [ 22 ] to skeletal pathology [ 5 , [23] , [24] , [25] ]. The results of the present study are consistent with these findings.…”

“…In the era of the first generation of CT, a report from UK showed the incidence of PA was 0.4/100,000 population years in 1980 [ 3 ]. Furthermore, some hospital-based observational studies regarding the incidence of PA have been reported recently [ [4] , [5] , [6] , [7] , [8] ] in the era of the fourth generation CT.…”