872. Retrospective Review of Pyogenic Diskitis and Vertebral Osteomyelitis in a Large Urban Medical Center
Session: Poster Abstract Session: Bone, Joint, and Soft Tissue Infection
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
Posters
  • PDVO.pdf (964.4 kB)
  • Background:

    Patients with pyogenic discitis and associated vertebral osteomyelitis (PDVO) are often left with chronic sequelae such as chronic pain, deformities or neurological deficits.  Most of the available data on PDVO are dated prior to 1988 or based on small case series that often focused on a particular organism, a defined risk factor, treatment or diagnostic modality. These studies are not able to provide adequate up-to-date information on this condition.

    Methods:

    A retrospective analysis of inpatient records with the diagnosis of PDVO between 1/1/2000 and 3/31/2012. Included records had evidence of PDVO by clinical syndrome, magnetic resonance imaging findings and/or computed tomography to support the diagnosis and/or by histopathological and/or microbiology of the specimens from surgery or biopsy.

    Results:

    Characteristics on (n=93) patients found:  mean age at diagnosis was 55.9 years. 63.4% were male; 57.0% were African American and 40.9% were white. 2.3% had prior spinal surgery.  1.2% having prosthetic material at the site of infection. Immunodeficiency was the predisposing factor in 4.3% and malignancy in 5.4%. 4.3% had history of IV drug use. Diabetes mellitus, and hypertension were reported as co-morbid conditions in 22.1% and 15.1% of cases, respectively. An intravascular source such as indwelling central vascular access, implanted AICD or pacemaker and infective endocarditis was present in 24.7% of the patients with an additional 17.4% on hemodialysis. In 22.6% of the patients no associated co-morbid condition was found. Leukocytosis and fever were uncommon. The causative organism was identified in 80.6% of subjects. The most common organisms were S. aureus(50.5%), gram negative rods (11.8%) and coagulase negative staphylococcus (10.7%). The most common infection site was lumbar (39.8%), followed by thoracic (28.0%), cervical (23.7%) and sacrum (8.6%). Surgical intervention was required in 80.6% of patients. Median duration of IV antibiotic treatment was 42 days.

    Conclusion:

    Indwelling central vascular access and hemodialysis were the most common associated conditions. The majority of patients required surgical interventions in addition to prolonged antibiotics.  With the aging population and increased rates of comorbid conditions more patients are at risk for developing PDVO.

    Arash Poursina, MD1, Wajid Siddiqui, MD2, David Parker, PhD1, Shana Dykema1 and Sharon Weissman, MD3, (1)University of South Carolina, Columbia, SC, (2)Infectious Disease, University of South Carolina, COLUMBIA, SC, (3)Medicine, University of South Carolina, Columbia, SC

    Disclosures:

    A. Poursina, None

    W. Siddiqui, None

    D. Parker, None

    S. Dykema, None

    S. Weissman, None

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