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Suspected disk space infection with negative microbiological tests-report of eight cases and comparison with
Jérôme Gillard1, David Boutoille, Stéphane Varin
1Rheumatology Department, Service de Rhumatologie, Hôtel-Dieu, Nantes Teaching Hospital, 1 place Alexis Ricordeau, 44093 Nantes cedex 1, France.
Unlabelled:
Few data are available on patients with suspected noniatrogenic pyogenic discitis but negative microbiological tests.
Objectives:
To compare the features, treatment, and outcomes in patients with suspected versus microbiologically documented noniatrogenic pyogenic discitis.
Patients:
A retrospective chart review identified eight patients with suspected noniatrogenic pyogenic discitis managed at our institution over a 15-year period. Eighteen age- and sex-matched patients with microbiologically documented noniatrogenic pyogenic discitis managed at our institution during the same period served as controls.
Results:
The eight cases had a longer time to diagnosis, a greater risk of abscess formation or epidural infection, and a smaller number of cutaneous portals of entry, as compared to the controls. None of the cases had evidence of endocarditis or diabetes mellitus. Infection at another site preceded the discitis in half the cases. Empirical treatment with two antimicrobials (usually a fluoroquinolone with a beta-lactam or fosfomycin) ensured a full recovery in all eight cases, with no relapses or long-term recurrences, whereas relapses occurred in three of the 18 controls treated with antibiotics selected by antibiotic susceptibility testing.
Conclusion:
Noniatrogenic pyogenic discitis with negative microbiological studies is associated with distinctive clinical features consistent with smoldering infection. The outcome is favorable under empirical two-drug antimicrobial therapy, usually including a fluoroquinolone given by the intravenous route.
Insights
Patients with suspected noniatrogenic pyogenic discitis and negative cultures often present with smoldering infections. Empirical two-drug antibiotic therapy, including a fluoroquinolone, leads to favorable outcomes without relapses.
Area of Science:
- Infectious Diseases
- Spinal Infections
- Microbiology
Background:
- Limited data exist for noniatrogenic pyogenic discitis cases with negative microbiological tests.
- This condition may present with distinct clinical features compared to documented cases.
Purpose of the Study:
- To compare clinical features, treatment strategies, and patient outcomes.
- To differentiate suspected noniatrogenic pyogenic discitis from microbiologically confirmed cases.
Main Methods:
- Retrospective chart review of patients with suspected and documented noniatrogenic pyogenic discitis.
- Comparison of eight suspected cases against 18 age- and sex-matched documented cases over 15 years.
Main Results:
- Suspected cases showed longer diagnosis times, higher risk of abscess/epidural infection, and fewer entry portals.
- All suspected cases recovered fully with empirical dual-drug therapy (fluoroquinolone/beta-lactam or fosfomycin).
- Relapses occurred in 3/18 documented cases treated with susceptibility-guided antibiotics.
Conclusions:
- Noniatrogenic pyogenic discitis with negative cultures suggests smoldering infection with unique features.
- Empirical intravenous dual-drug therapy, typically with a fluoroquinolone, yields favorable outcomes.
