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Purpose <p>To describe the epidemiology, diagnosis, microbiological findings, clinical features, and outcomes of infectious spondylodiscitis (IS).</p> Methods <p>Retrospective analysis of 98 IS patients (2010–2023 - Trieste Hospital). Clinical, radiological, and microbiological data analysed, multivariate logistic regression assessed risk factors for poor outcomes.</p> Results <p>The incidence of IS was 3 cases per 100,000 inhabitants per year. Pyogenic infections accounted for 54% of cases, tuberculosis for 10%, while 35% remained of unknown etiology. Back pain (79%) and fever (72%) were the most common symptoms. <i>Staphylococcus aureus</i> was the most common pathogen, with 34 cases, representing 64% of pyogenic spondylodiscitis. Blood cultures were positive in 47% of pyogenic cases, 25% of all cases. PET/CT showed higher diagnostic utility (83%) than labeled leukocyte scintigraphy (54%). The lumbar spine was the most affected region (63%), followed by thoracic (25%) and cervical (12%). Neurosurgical biopsy showed a 33.3% positivity rate, while CT-guided biopsy yielded 22%. Cervical (OR 4.76) and thoracic (OR 3.89) involvement were associated with worse outcomes. Major complications included radicular nerve damage (51%), epidural/paravertebral abscesses (45%), endocarditis (14%), and a need for surgical intervention in 8%, with persistent neurological sequelae in 3%. Infection-related mortality rate was 6%.</p> Conclusion <p><i>S. aureus</i> remains the leading pathogen in IS. Blood cultures play a key role, yielding positive in half of pyogenic cases. PET/CT surpassed leukocyte scintigraphy and improved MRI diagnostic accuracy. Lumbar involvement correlates with better outcomes, and open biopsy provides a higher diagnostic yield than percutaneous TC-guided biopsy. Empirical therapy is required in one-third of cases.</p>

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Infectious spondylodiscitis: Epidemiology, diagnosis, microbiological findings, clinical features and outcomes in a 14-year retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月29日

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  • Jacopo Conti,
  • Nicholas Geremia,
  • Stefano Di Bella,
  • Fulvio Zadra,
  • Verena Zerbato,
  • Stella Babich,
  • Venera Costantino,
  • Manuela Di Santolo,
  • Marina Busetti,
  • Filippo Mearelli,
  • Leonello Tacconi,
  • Marco Francesco Maria Cavallaro,
  • Maria Assunta Cova,
  • Gianni Biolo,
  • Roberto Luzzati,
  • Donatella Giacomazzi

摘要

Purpose

To describe the epidemiology, diagnosis, microbiological findings, clinical features, and outcomes of infectious spondylodiscitis (IS).

Methods

Retrospective analysis of 98 IS patients (2010–2023 - Trieste Hospital). Clinical, radiological, and microbiological data analysed, multivariate logistic regression assessed risk factors for poor outcomes.

Results

The incidence of IS was 3 cases per 100,000 inhabitants per year. Pyogenic infections accounted for 54% of cases, tuberculosis for 10%, while 35% remained of unknown etiology. Back pain (79%) and fever (72%) were the most common symptoms. Staphylococcus aureus was the most common pathogen, with 34 cases, representing 64% of pyogenic spondylodiscitis. Blood cultures were positive in 47% of pyogenic cases, 25% of all cases. PET/CT showed higher diagnostic utility (83%) than labeled leukocyte scintigraphy (54%). The lumbar spine was the most affected region (63%), followed by thoracic (25%) and cervical (12%). Neurosurgical biopsy showed a 33.3% positivity rate, while CT-guided biopsy yielded 22%. Cervical (OR 4.76) and thoracic (OR 3.89) involvement were associated with worse outcomes. Major complications included radicular nerve damage (51%), epidural/paravertebral abscesses (45%), endocarditis (14%), and a need for surgical intervention in 8%, with persistent neurological sequelae in 3%. Infection-related mortality rate was 6%.

Conclusion

S. aureus remains the leading pathogen in IS. Blood cultures play a key role, yielding positive in half of pyogenic cases. PET/CT surpassed leukocyte scintigraphy and improved MRI diagnostic accuracy. Lumbar involvement correlates with better outcomes, and open biopsy provides a higher diagnostic yield than percutaneous TC-guided biopsy. Empirical therapy is required in one-third of cases.