Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years’ intensive care experience

Abstract

Introduction: Management of pyogenic spinal infections (PSI) after the development of neurological deficit has not been specifically addressed in the literature. We aimed to describe real-life clinical outcomes of PSI in patients admitted to an intensive care unit with neurological deficit and identify factors associated with good prognosis.
 Methodology: Consecutive patients admitted to ICU with a possible diagnosis of spinal infection over five years’ period were included. Descriptive statistics were performed to examine the demographics and clinical parameters.
 Results: The majority (71%) of patients were male. The mean age was 57.4 years (27-79), and 71% were > 50 years old. At least one underlying risk factor was identified in 68% of the patients; the most common comorbidity was diabetes mellitus (DM). All patients have presented with fever accompanied by a neurological deficit (86%) and back pain (79%). A complete recovery was achieved in 25% of patients. However, the majority of patients had adverse outcomes with 21.4% mortality, and 43% remaining neurological sequelae. Increased age with a cut-off of 65 years and pre-existing DM were identified as being associated with poor outcome.
 Conclusion: Mortality among patients admitted to ICU with PSI was significantly higher than reported in the literature. The residual neurological deficit was common, one-third of patients had remaining neurological sequelae, and only one-fourth had complete recovery. Increased age and background DM were the most important determinants of poor clinical outcome. The impact of DM appears to be much more important than currently recognised in this population.

Pyogenic Spondylodiscitis: Risk Factors for Therapeutic Failure and Recurrence

“…PS is recognized as a challenging disease with potentially devastating clinical consequences. 2,4,9,[11][12][13] In keeping with the literature, most of the patients were middle-aged or elderly men. [1][2][3][4][5][6][7][8][9][10][11] Other findings also described in previous studies included back pain in nearly all cases, 4,10,14 fever in about one-third of patients, 10 an increase in systemic inflammatory markers as a common feature, 5,10 and the predominance of Staphylococcus aureus among the causative agents.…”

“…Following the broad literature, our study also reported a high prevalence of residual symptoms among those recovering from infection. 5,13,18 This finding highlights that PS continues to lead to neurological sequelae, chronic pain, and long-term disability. However, its mortality has dropped over the last decades due to the wide use of antibiotics.…”

“…However, its mortality has dropped over the last decades due to the wide use of antibiotics. 5,13,18 Although its growing importance, few studies report prognostic factors associated with therapeutic failure or recurrence. Besides, the outcomes definitions related to PS are not well standardized, which makes it difficult to compare results among different studies.…”

The Need for Comprehensive Medical Management in Pyogenic Spondylodiscitis: A Review Article

“…Comprehensive Medical Management in Pyogenic Spondylodiscitis 6 multiple comorbidities, most commonly diabetes mellitus (DM) 11 . Those over 65 years old are at a high risk of having neurological complications 12 , including those with DM and rheumatoid arthritis 13 . Other risk factors that increase mortality include end-stage renal disease that needs hemodialysis, liver cirrhosis, malignancy, infective endocarditis 11 , and chronic steroid use 3 .…”