Espondilodiscitis infecciosas del adulto. Estudio de 76 pacientes y revisión de la literatura
Adult infectious spondylodiscitis. Trial of 76 patients and review of the literature
Salud(i)ciencia (Impresa); 14 (5), 2006
Publication year: 2006
In adults, infectious spondylodiscitis (IS) represents only 2-5% of all osteomyelitis, and experience in its clinical management is limited. We studied retrospectively the clinical presentation, laboratory test, imaging techniques, therapeutic interventions, and outcome of adult IS diagnosed in POVISA hospital between January 1978 and December 2005. Seventy-six cases of IS (48 male and 28 female) were identified, 29 tuberculous (TS) and 47 non tuberculous (NTS). The age at the time of the diagnosis was 47.1 ± 17.5 (mean ± SD). TS were the most frequent IS between1978 ad 1991. All patients suffered inflammatory pain in the involved spinal segment, and 41% of them also presenting neurological signs. NTS were associated with a high frequency of fever (64% vs. 41.4%; p < 0.05) and leucocytosis (57.4% vs. 6.9%; p < 0.0001). Active extra-vertebral tuberculosis was found in 14 (48%) cases of TS. Systemic risk factors were identified in 25% of patients and a portal of entry was presumed in 28 (59.6%) NTS: surgical spinal procedures (11), cutaneous infections (5), vascular catheter infections (3), intravenous drug abuse (3), ginecological surgery (2), urinary infections (2), pneumonia (1) and pyorrhea (1). Staphylococcus aureus was the commonest pathogen, comprising 31 (66%) of the 47 NTS, follows by Streptoccocus spp. (6) and coagulasa negative Staphylococcus (3). Klebsiella pneumoniae, Proteus mirabilis, Salmonella typhi, Pseudomonas aeruginosa, Escherichia coli and Brucella abortus were the remaining causative agents. Only 8% of infectious spondylodicitis involved the cervical spine. Epidural abscess were diagnosed in eight (8,5%) patients. TS was associated with greater diagnosis delay (22.5 ± 16 vs. 5.1 ± 3.1 weeks, p < 0.001), and more residual spinal kyphosis and/or scoliosis (65% vs. 17%, p < 0.002). Unfortunately, delay from onset to diagnosis of IS continues to be excessive, and exceeded to four months in the NTS. This fact is associated with more residual spinal deformity. Physicians should be aware of the possibility of IS in any patient that presents with spinal inflammatory pain, fever and/or increased of acute phase reactants.
Sólo 2% a 5% del total de las osteomielitis del adulto afectan la columna vertebral y la experiencia de la mayoría de los clínicos en su manejo es escasa. Estudiamos retrospectivamente las manifestaciones clínicas, biológicas, radiológicas, así como el tratamiento y la evolución de las espondilodiscitis infecciosas con etiología confirmada, diagnosticadas en el hospital POVISA desde enero de 1978 hasta diciembre de 2005. Se recolectaron 29 espondilodiscitis tuberculosas (EIT) y 47 no tuberculosas (EINT), todas monobacterianas, en 48 varones y 28 mujeres cuya edad era de 47.1 ± 17.5 años (media ± DE). De 1978 a 1991 predominaron las EIT y, en el resto del período, las EINT. Todos los enfermos presentaron dolor de ritmo inflamatorio en el segmento vertebral afectado y en el 41% hubo signos de compromiso mielorradicular. En las EINT fueron más frecuentes la fiebre (64% vs. 41.4%; p < 0.05) y la leucocitosis (57.4% vs. 6.9%; p < 0.0001). En 14 (48%) EIT se detectaron otros focos tuberculosos. Existieron factores predisponentes sistémicos en el 25% de los enfermos. En 28 EINT (59.6%) se identificó una puerta de entrada, destacándose la cirugía previa del raquis (11) y las infecciones cutáneas
(5). Su principal agente etiológico fue Staphylococcus aureus (31/47; 66%), seguido del género Streptococcus (6) y los estafilococos coagulasa negativos (3).