Diagnostic delay of pyogenic vertebral osteomyelitis and its associated factors

Jean, Maxime; Jo, Irisson; Gras, Guillaume; Bouchand, Frédérique; Simó, D.; Duran, Clara; Perronne, Christian; Mulleman, Denis; Bernard, Louis; Dinh, Aurélien

doi:10.3109/03009742.2016.1158314

Cited by 39 publications

(27 citation statements)

References 19 publications

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“…We speculate, physicians may delay obtaining blood cultures in patients with lower CRP level, similar to delay in diagnosis of vertebral osteomyelitis related to lower CRP level. [ 20 ] Physicians may attribute either viral infections or some other non-bacterial causes in patients with the lower CRP level. Moreover, our research (data not shown in the part of Results) showed that patients with IE attributed to streptococcus species had lower CRP levels.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with delayed diagnosis of infective endocarditis

Nishiguchi

Nishino

Kitagawa³

et al. 2020

Medicine

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Patients with infective endocarditis (IE), have high mortality and morbidity, however, its early diagnosis is difficult. Few studies have examined the delayed diagnosis of IE. We aimed to investigate the factors associated with the diagnostic delay of IE. A retrospective cohort study was conducted for consecutive patients diagnosed with IE in an acute care teaching hospital in Japan from April 2006 to March 2018. Time-to-diagnosis was analyzed using a multivariate Cox hazard model for determining factors associated with days required for IE diagnosis. Factors analyzed in the model included age, gender, activities of daily living, Charlson comorbidity index, presence of internal device, chief complaint, inappropriate antibiotics use, shaking chill, fever >38°C, hypoxemia, serum C-reactive protein (CRP) < 10 mg/dL, Staphylococcus aureus as causative pathogen, findings on first echocardiography, resident as a first contact physician, primary care physician as a first contact doctor, and transport measures to the clinic/hospital. There were 145 IE patients with a mean age of 70 years and 90 were male (62.1%). The median time to the diagnosis of definite IE was 13 days and median time to consider the diagnosis of IE from first clinic/hospital visit was 6 days. The time to consider IE diagnosis was significantly delayed in patients who had inappropriate prior antibiotic use (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.01 to 2.57; P = .045), in patients without fever >38°C (HR, 1.80; 95% CI, 1.11 to 2.90; P = .016), in patients with serum CRP level < 10 mg/dL (HR, 1.53; 95% CI, 1.01 to 2.33; P = .046), and in patients who did not use an ambulance for hospital arrival (HR, 3.18; 95% CI, 1.72 to 5.85; P < .001). Delay in considering IE diagnosis is associated with inappropriate prior antibiotics use, absence of high fever, absence of high CRP level, and use of a hospital arrival vehicle other than an ambulance. For earlier IE diagnosis, inappropriate use of antibiotics should be avoided and IE should not be excluded by relatively low level of temperature or serum CRP.

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Section: Discussionmentioning

confidence: 99%

Factors associated with delayed diagnosis of infective endocarditis

Nishiguchi

Nishino

Kitagawa³

et al. 2020

Medicine

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“…Leukocytosis is not necessarily present, whereas increased CRP is seen in 90%-98% of cases (4, e15). Jean et al showed that an increased CRP can shorten the time to diagnosis compared with other laboratory parameters (9). The procalcitonin (PCT) level plays a minor role as a parameter of sepsis in the primary diagnosis of spondylodiscitis, is more cost-intensive than CRP determination, and is not suitable as a follow-up parameter (11).…”

Section: Laboratory and Microbiological Testsmentioning

confidence: 99%

“…The remaining authors state that they have no conflict of interests. High CRP (56 days shorter) or positive blood culture (60 days shorter) are associated with a shorter diagnostic delay (2017) (9) Diabetes as a predisposing factor (2009) (10)…”

Section: Conflict Of Interest Statementmentioning

confidence: 99%

Spondylodiscitis: Diagnosis and Treatment Options

Herren

Jung

Pishnamaz

et al. 2017

Deutsches Ärzteblatt International

147

161

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“…Symptoms can also be misattributed to unremitting back pain from degenerative spinal disorders. As a result, the diagnosis of spinal infections can often be delayed and result in severe neurological complications [9]. Physical examination may reveal localized spinal tenderness over involved regions with limited range of motion.…”

Section: Clinical Evaluationmentioning

confidence: 99%

Evaluation and Management of Pyogenic and Tubercular Spine Infections

Boody

Tarazona

Vaccaro

2018

Curr Rev Musculoskelet Med

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Purpose of Review To review the most current diagnostic tools and treatment options for pyogenic and tubercular spine infection. Recent Findings Recent studies have focused on risk factors for failed nonoperative management in order to improve patient selection. Also, spine instrumentation and different grafting options have been safely utilized in the setting of an active infection without increasing the incidence of reoccurrence. However, the optimal surgical technique has yet to be established and instead should be patient specific. Summary Spine infections include a broad spectrum of disorders including discitis, vertebral osteomyelitis, and spinal epidural abscess. It is paramount to recognized spine infections early due to the potential catastrophic consequences of paralysis and sepsis. The management of spine infections continues to evolve as newer diagnostic tools and surgical techniques become available. Magnetic resonance imaging with contrast is the imaging study of choice and computed tomography-guided biopsies are crucial for guiding antibiotic selection. Antibiotics are the mainstay of treatment and surgery is indicated in patients with neurological deficits, sepsis, spinal instability, and those who have failed nonoperative treatment.

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Diagnostic delay of pyogenic vertebral osteomyelitis and its associated factors

Abstract: Despite easier access to MRI, the DD for PVO remains long. One shortening factor is a high CRP value, which could be a useful diagnostic tool in case of back pain. Anti-inflammatory drugs seem to have no impact on DD and severity at diagnosis.

Cited by 39 publications

References 19 publications

Factors associated with delayed diagnosis of infective endocarditis

Factors associated with delayed diagnosis of infective endocarditis

Spondylodiscitis: Diagnosis and Treatment Options

Evaluation and Management of Pyogenic and Tubercular Spine Infections

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