Abstract

CARVALHO, Vanessa Novais de et al. Infectious Spondylodiscitis: Presentation, Diagnosis and Treatment. Medicina Interna [online]. 2018, vol.25, n.2, pp.85-90. ISSN 0872-671X.  https://doi.org/10.24950/rspmi/original/218/2/2018.

Introduction: Clinical presentation of spondylodiscitis is heterogeneous. Its diagnosis is sometimes challenging. The authors characterize and evaluate the prevalence of spondylodiscitis in a Department of Internal Medicine (DIM). Population/Methods: Observational retrospective study of all patients with spondylodiscitis diagnosis at discharge from 2007 to 2016. Demographic variables, presentation symptoms, risk factors, site of infection, etiology and management were accessed. Results: Thirty three cases of spondylodiscitis (19 men, mean age 77 ± 15.5 years) were identified, performing a prevalence of 0.3%. The more frequent symptoms at presentation were flank pain, fever and neurological disorders. Twelve patients had concomitant infection, eight diabetes mellitus and four cancer. Four patients undergone surgery < 6 months, three had chronic hepatic disease and one was an intravenous drug consumer. Twenty-five patients had elevated leukocyte count and/or RCP. Twenty-one patients underwent magnetic resonance imaging (MRI) and computed tomography (CT) scan, six only MRI, four only CT scan and one only positron emission tomography. Fifteen patients underwent biopsy. The most frequent location was the lumbar spine at L4-S1. In 11 patients blood cultures were positive for Escherichia coli ESBL, Staphylococcus aureus methicillin-resistant (MRSA) or methicillin-sensitive Staphylococcus aureus (MSSA) and in one biopsy identified Mycobacterium tuberculosis. The antibiotic scheme was vancomycin and ciprofloxacin for patients with MRSA and negative cultures, meropenem or piperacillin/ tazobactam and ciprofloxacin for patients with E. coli ESBL, flucloxacillin for patients with MSSA. The average duration of treatment was 5 weeks. Conclusion: Patients with spondylodiscitis are older patients with co-morbidities. Imagiologic studies are essential for diagnosis as symptoms and laboratory changes may be absent.

Keywords : Bacterial Infections/diagnosis; Bacterial Infections/therapy; Discitis/diagnosis; Discitis/therapy; Intervertebral Disc.

        · abstract in Portuguese     · text in Portuguese     · Portuguese ( pdf )