Predictors of conservative treatment for pyogenic spondylitis

Abstract

Abstract:Introduction: Although initial treatments for pyogenic spondylitis include conservative approaches such as rest and antibiotics, some cases are refractory to conservative therapy. The objective of this study was to clarify the predictors for achievement of C-reactive protein (CRP) normalization in pyogenic spondylitis by conservative therapy.Methods: In the present study, we enrolled 83 patients (51 men and 32 women) with conservatively treated pyogenic spondylitis from 2006 to 2015. Multiple logistic regression analysis was used to examine the association of achievement of CRP normalization with the number of infected vertebrae, bacterial strain, blood data, and the expansion of abscess to the epidural space by using functional magnetic resonance imaging.Results: We found significant differences in the subjects with and without achievement of CRP normalization with respect to age, the number of affected vertebrae, ratio of resistant pathogenic bacteria, ratio of expansion of abscess to the epidural space, and blood data such as Hb, ALB, eGFR, Cr, and ALP levels.After adjustment for age and sex, the number of infected vertebral bodies, resistant bacteria, expansion of abscess to the epidural space, and Hb level showed significant associations with the normalization of CRP. In addition, we used multiple logistic regression analysis with age, sex, number of infected vertebral bodies, resistant bacteria, expansion of abscess to the epidural space, and serum Hb level as explanatory variables. We found that expansion of the abscess to the epidural and paravertebral spaces was significantly associated with the normalization of CRP level.Conclusions: The number of infected vertebral bodies, resistant strains of pathogenic bacteria, expansion of abscess to the epidural and paravertebral spaces, and serum Hb level predicts the prognosis of patients with pyogenic spondylitis. Particularly, expansion of abscess to the epidural and paravertebral spaces was strongly associated with the achievement of CRP normalization.

Evaluation of Percutaneous Pedicle Screw Fixation in Patients with Pyogenic Spondylitis of the Thoracolumbar Spine

“…In this study, the percentage of elderly patients was 75.9 %, and it [19]. Among these causative organisms, MRSA has the risk of Non-inversion of CRP [9] and Life expectancy reduction [20]. In this study, 6 cases infecting MRSA of those 3 cases (50%) die in 1 year.…”

“…There has been a considerable increase in patients of pyogenic spondylitis during the last 15 years [8]. Some reports show this increase was attributed to improved life expectancy of patients with chronic disease [2] [9], better diagnostic imaging [10]. And also reported percentages of elderly patients (over 60 years old) among total cases of pyogenic spondylitis treated surgically are 40% -46% [11] [12] [13].…”

Factors predicting the duration required to control infection in pyogenic spondylitis: A retrospective observational study

“…This result is consistent with a previous report that revealed that the presence of 3 or more infected vertebral bodies was associated with an increased risk of CRP normalization failure. [5] As shown in Fig. 2, the number of infected vertebrae cutoff value for prolonged hospitalization was 3.…”

“…[4] Therefore, it is vital to consider strategies to reduce the length of time required to control the infection in pyogenic spondylitis and lower the cost of care. To date, the following risk factors have been reported for refractory pyogenic spondylitis: lower hemoglobin count, [5] higher C-reactive protein (CRP) concentration, [6,7] expansion of an abscess to the epidural spaces, [5,6,8] expansion of an abscess to the paravertebral spaces, [5,6] the number of infected vertebral bodies, [5,8] resistant strains of pathogenic bacteria, [5] duration of symptoms, [7] neurologic de cit, [6] underlying diabetes, [8] fever, [8] and age, [6] among others. However, to our knowledge, there have been few reports on the factors associated with the duration required to control the infection in pyogenic spondylitis.…”

Three-Staged Surgical Strategy as a Combined Approach for Multilevel Cervical Pyogenic Spondylodiscitis

“…Cervical pyogenic spondylodiscitis tends to exhibit rapid progression, leading to severe neurological deficits; hence, early surgical treatment is required in cases showing signs of structural instability or neurological deterioration [7][8][9]. However, there are few reports on the strategy of medical and surgical treatments for multilevel cervical pyogenic spondylodiscitis.…”