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Introduction: Management of pyogenic spinal infections (PSI) after the development of neurological deficit has not been specifically addressed in the literature. We aimed to describe real-life clinical outcomes of PSI in patients admitted to an intensive care unit with neurological deficit and identify factors associated with good prognosis., Methodology: Consecutive patients admitted to ICU with a possible diagnosis of spinal infection over five years' period were included. Descriptive statistics were performed to examine the demographics and clinical parameters., Results: The majority (71%) of patients were male. The mean age was 57.4 years (27-79), and 71% were > 50 years old. At least one underlying risk factor was identified in 68% of the patients; the most common comorbidity was diabetes mellitus (DM). All patients have presented with fever accompanied by a neurological deficit (86%) and back pain (79%). A complete recovery was achieved in 25% of patients. However, the majority of patients had adverse outcomes with 21.4% mortality, and 43% remaining neurological sequelae. Increased age with a cut-off of 65 years and pre-existing DM were identified as being associated with poor outcome., Conclusion: Mortality among patients admitted to ICU with PSI was significantly higher than reported in the literature. The residual neurological deficit was common, one-third of patients had remaining neurological sequelae, and only one-fourth had complete recovery. Increased age and background DM were the most important determinants of poor clinical outcome. The impact of DM appears to be much more important than currently recognised in this population., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2020 Branko Milosevic, Muge Cevik, Aleksandar Urosevic, Natasa Nikolic, Jasmina Poluga, Milica Jovanovic, Ivana Milosevic, Jelena Micic, Bianca Paglietti, Aleksandra Barac.)

Background Context: Information on short- and especially long-term mortality among patients with infectious spondylodiscitis is sparse., Purpose: To analyze mortality, factors associated with death, and cause-specific mortality rates among patients with infectious nonpostoperative spondylodiscitis., Study Design: A case-cohort study., Patient Sample: We identified all patients aged 18 years or older treated for infectious spondylodiscitis from January 1994 to May 2009 at hospitals in Funen County, Denmark., Outcome Measures: Overall and cause-specific mortality., Methods: Mortality rates among patients were compared with rates among a reference population using Kaplan-Meier plots and mortality rate ratios (MRRs). Short-term mortality was defined as deaths within first year after admission and long-term mortality was deaths thereafter. Factors associated with death were determined., Results: Among 298 identified patients, 61 (20%) died within the first year. Adjusted MRRs were 16.8 (95% confidence interval: 9.9-28.5) for 0 to 90 days; 4.2 (2.5-7.0) for 91 to 365 days; 2.2 (1.6-2.9) for 1 to 4 years; and 1.7 (1.2-2.5) for 5 to 14 years. Mortality rate ratios stratified on microbiological etiology were 8.8 (3.3-22.1) for 0 to 90 days; 1.4 (0.3-5.8) for 91 to 365 days; 3.2 (2.0-5.1) for 1 to 4 years; and 1.1 (0.5-2.4) for 5 to 14 years for unknown etiology and 24.0 (13.0-44.2) for 0 to 90 days; 6.0 (3.1-11.5) for 91 to 365 days; 1.9 (1.1-3.2) for 1 to 4 years; and 2.7 (1.5-4.7) for 5 to 14 years among Staphylococcus aureus infections. The main factors associated with short-term mortality were severe neurologic deficits at the time of admission, epidural abscess, and comorbidities. Long-term mortality seemed independent of microbiological etiology., Conclusions: Mortality remained high the first year after admission and thereafter decreased with time to a level close to the reference population. Short-term mortality was especially related to infection with abscess formation and neurologic deficits and long-term mortality was related to alcohol dependency., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: To determine the long-term mortality and the causes of death after Staphylococcus aureus spondylodiscitis., Methods: Nationwide, population-based cohort study using national registries of adults diagnosed with non postoperative S. aureus spondylodiscitis from 1994-2009 and alive 1 year after diagnosis (n Z 313). A comparison cohort from the background population individually matched on sex and age was identified (n Z 1565). Kaplan-Meier survival curves were constructed and Poisson regression analyses used to estimate mortality rate ratios (MRR) adjusted for comorbidity., Results: 88 patients (28.1%) and 267 individuals from the population-based comparison cohort (17.1%) died. Un-adjusted MRR for S. aureus spondylodiscitis patients was 1.77 (95% CI, 1.39-2.25) and 1.32 (95% CI, 1.02-1.71) after adjustment for comorbidity. We observed increased mortality due to infectious (MRR 8.57; 95% CI, 2.80-26.20), endocrine (MRR 3.57; 95%CI, 1.01-12.66), cardiovascular (MRR 1.59; 95% CI, 1.02-2.49), gastrointestinal (MRR 3.21; 95% CI, 1.178.84) and alcohol and drug abuse-related (MRR 10.71; 95% CI, 3.23-35.58) diseases., Conclusions: Patients diagnosed with S. aureus spondylodiscitis have substantially increased long-term mortality, mainly due to comorbidity. To improve survival after S. aureus spondylodiscitis these patients should be screened for comorbidity and substance abuse predisposing to the disease [corrected]., (Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)

Infective spondylodiscitis (ISD) is a rare but potentially devastating condition in hemodialysis (HD) patients. Reports are limited especially in patients receiving high-flux HD and hemodiafiltration (HDF). In a retrospective analysis, 13 patients on our maintenance high-flux HD/HDF program were identified as having has infective spondylodiscitis over a 10-year period (1997-2006), an incidence of approximately 1 episode every 215 patient-years. The incidence was around 3 times higher in patients dialyzing with tunnelled central venous catheters (TCVC) than in those with arteriovenous fistulae. Affected patients were elderly (mean age 70 years) and had multiple comorbidities. Access problems, particularly TCVC infection, were common in the months preceding it's onset. Tunnelled central venous catheter removal during these episodes did not necessarily prevent it. Diagnosis was based on a history of back pain, raised C-reactive protein, positive blood cultures, and characteristic magnetic resonance findings. Many patients were apyrexial and had normal white cell counts. In our patients on high-flux HD/hemodiafiltration, its incidence appears comparable to that in conventional HD settings. No patients had infection with waterborne organisms. Blood cultures were positive in 77%. Gram-positive organisms predominated, particularly Staphylococcus aureus. The major route of infection was hematogenous, with the most likely source the venous access. All received antibiotics for 6 to 12 weeks or until death. Only 2 patients underwent surgical drainage. Mortality was high (46%) and predicted by the development of complications, and by pre-existing cardiovascular comorbidity. Prevention, using strategies to reduce the prevalence of bacteremia, including limiting the use of TCVC, should be an overriding aim.

Study Design: Retrospective case series., Objective: To determine relevant demographics, clinical presentations, and outcomes of this condition., Summary of Background Data: This is the first study looking specifically at methicillin-resistant Staphylococcus Aureus (MRSA) spondylodiscitis., Methods: We performed a retrospective review of patients presenting between 2000 and 2005., Results: Thirteen cases were identified. The mean age was 65 years; 85% were male. All cases presented with back pain, spinal tenderness, and systemic upset. Neurologic deficit was present initially in 39%, and 8% developed neurologic deterioration during treatment. The thoracic spine (53%) was most commonly affected, followed by the lumbar (33%), thoracolumbar junction (7%), and cervical spine (7%); 16% of cases were multilevel. The white cell count, erythrocyte sedimentation rate and C-reactive protein were elevated in all cases with means of 17.3 x 10(-9)/L, 102 mm/h, and 236 mg/L, respectively. Radiologic diagnosis was established with MRI in all cases. The most common risk factors were diabetes mellitus (62%), malnourishment (54%), cirrhosis (31%), end-stage renal failure (15%), and intravenous drug use (15%). Multiple risk factors were present in 76% of cases, and only 15% had no identifiable risk factors. The main sources of sepsis were intravenous catheters (23%), urinary tract (15%), and intravenous drug use (15%). Treatment consisted of intravenous vancomycin monotherapy for a mean period of 4 weeks followed by oral combination or monotherapy antimicrobials for a mean period of 8 weeks. Operative intervention was required in 38% of cases. At 6 months, 54% of cases were clinically free of infection, 38% had died, and 8% required ongoing treatment. Neurologic deficit was present in 50% of survivors. At 1 year, 29% of survivors had MRSA bacteremia and spondylodiscitis recurrence., Conclusion: This is a devastating condition with high mortality and morbidity.