Espondilodiscitis infecciosas en un área sanitaria gallega, 1983-2003

Abstract

Objective: To study the clinical-epidemiological characteristics of infectious spondylodiscitis (IS) in adults of our health area in the late 20 years. Material and methods: We performed a retrospective analysis of the medical records of adult patients with a diagnosis of both, tuberculous (TS) and non tuberculous spondylodiscitis (NTS), between January 1983 and December 2003. The diagnosis was made when compatible clinical-radiological picture were present in association with at least two positive blood cultures and/or micro-organism recovery from vertebral samples. Additionally, TS was diagnosed when biopsy showed typical caseating granulomas from vertebral or extra-vertebral lesions. Results: 17 TS and 22 NTS were identified. The mean age was lower in patients with TS than in NTS (43.5 ± 24.6 vs 52.0 ± 15.2 years; mean ± SD). Patients were predominately males in both, TS (57%) and NTS (82%; p < 0001). The time between the onset of symptoms and diagnosis was longer in TS (16,4 ± 15,2 weeks) than in NTS (3.9 ± 3.2 weeks), p= 0.005. Seven (41%) of the 17 patients with TS had active extra-vertebral tuberculosis. A source of infection was presumed in 20 NTS (90%), mainly surgical spinal procedures (9/22.41%). In three TS and four NTS one o more predisposing factors were observed. The patients with NTS presented a higher prevalence of fever (41% vs 24%; p= 0.0003) and leucocytosis (41% vs 12%; p< 0.001), but less neurological impairment (9% vs 21% p= 0,01). None patient with NTS presented mixed infection and Staphylococcus aureus was the main pathogen (14/22.64%) follows by Streptococcus sp (6/2.2.27%). KIebsieIIa pneumoniae and Proteus mirabilis were the remain causative agents. Spinal cord decompression and surgical drainage of abscess were performed in five patients (24%) with TS and four patients with NTS (18%), p= 0.0027). Neurological sequels were more common in the patients with TS (24% vs 14%, p= 0.008). The global incidence of 1S was 2.2 cases/10 5 inhabitants/year, which 1.73 cases are NTS. Conclusions: The 1S are a unusual disease what occurs predominantly in male patients. In the last 10 years, a increasing prevalence of NTS was observed, with high contribution (41%) of post-surgical cases. Diagnostic delay is greater in patients with TS and this condition was associated with more neurological sequels.