SAT0468 INFECTIOUS SPONDYLODISCITIS IN A SPANISH REGIONAL HOSPITAL BETWEEN 2000 AND 2018: 66 CASES
Authors: Isla Morante Bolado, Montserrat Santos Gómez, Ignacio Villa-Blanco, Leyre Riancho Zarrabeitia, Elena Aurrecoechea, Teresa Ruiz Jimeno, Jaime Calvo
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Spondylodiscitis have a large spectrum of clinical manifestations. The early diagnosis and treatment of this condition are essential to give the patient the best chance of a good outcome. <h3>Objectives</h3> To analyze the clinical characteristics, most frequent diagnostic methods and different treatments used in spondylodiscitis (SD) in our sanitary area. <h3>Methods</h3> Descriptive and retrospective study of patients with the diagnose of infectious SD (clinical or microbiological) from 2000 to 2018. In each case we studied the presence of underlying diseases, an episode of infection in the previous 6 months, way of presentation, location, diagnostic methods, treatment and evolution, comparing among different etiologies. <h3>Results</h3> 66 patients were diagnosed of spondylodiscitis. 44 men (24-90 years: mean 71.7). 62 were pyogenic, 3 tuberculous (TBC) SD, and 1 candida. The patients with TBC were younger (mean age: 45.3; p&lt;0.05). An underlying disease was observed in 51 patients, specially Diabetes Mellitus (DM) (31% of SD). 4 patients were Rheumatoid Arthritis patients. A previous episode of bacteriemia or a primary source of infection was identify in a 34.8% of the cases, obtaining a microbiological isolation in 50/66 (75.7%) SD (46 bacterial, 3 TBC and 1 Candida). The most frequent pathogens were Gram +(G+) (51% of the total SD) being S. aureus and S epidermidis responsible of 23/66 cases (34.8%). In the 94% of SD caused by G+, hemocultures positive were obtained, in comparison to a 55% of SD caused by G- (p=0.016). The most frequent presentation symptoms were: lumbar pain (90%), fever (53%) and neurological deficit (19%). Leucocytosis was present in only a third of the SD, observing an increase of ESR and CRP in the pyogen etiology (p no significative for low number of patients in SD group caused by TBC) and lower levels of hemoglobin, cholesterol and albumin. Lumbar area was affected in the 75.7% of SD (77% in G+ and 50% in G-). In a 13.6% of patients, more than one intersomatic space was affected, being visible the presence of an abscess in 47/66 cases (71.2%). It was necessary surgical treatment in 10/47 (21.2%). 5 patients died due to pathology related to SD (7.5%), without any correlation with a risk factor and other 5 presented a relapse in the subsequent months. <h3>Conclusion</h3> - The bacterial SD are the predominant group, being DM the most frequent risk factor. - The incidence of SD due to TBC and fungi is scarce in our environment, being absent the Brucella etiology. - The G+ SD usually have a previous associated bacteriemia. - The majority of the patients had pain in the presentation, but only half of them had associated fever. - The most frequent location of SD was lumbar. - We established a 7.5% of mortality rate in our sanitary area. <h3> Disclosure of Interests</h3> Isla Morante Bolado: None declared, Montserrat Santos Gómez: None declared, Ignacio Villa-Blanco: None declared, Leyre Riancho Zarrabeitia: None declared, Elena Aurrecoechea: None declared, Teresa Ruiz Jimeno: None declared, Jaime Calvo Consultant for: Bristol-Myers Squibb, Janssen, Celgene, Sanofi Genzyme, Speakers bureau: Bristol-Myers Squibb