Does Pathogen Identification Influence the Clinical Outcomes in Patients With Pyogenic Spinal Infections?
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Published on: December 3, 2017
Julio Urrutia1, Mauricio Campos, Tomas Zamora
1Departments of *Orthopaedic Surgery †Clinical Laboratories, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Study Design:
Retrospective study.
Objective:
To study the clinical outcomes of patients suffering from pyogenic spinal infections (PSI), by comparing the outcomes of patients with an identified microbiological agent with those of patients without an identified pathogen.
Summary Of Background Data:
PSI is associated with significant risks for morbidity and mortality. Specific antibiotic treatment has been considered a key to successful medical treatment; however, clinicians frequently treat patients with PSI without an identified agent. A paucity of data is available comparing the clinical outcomes of patients with or without an identified pathogen.
Materials And Methods:
The records of 97 consecutive patients discharged from a University Hospital with the diagnosis of PSI during a 14-year period were retrospectively reviewed. Patients' demographics, etiological agent, comorbidities, site of infection, white blood cell count, erythrocyte sedimentation rate, C-reactive protein at the time of presentation, neurological impairment, length of hospital stay, and mortality were registered to compare the clinical outcomes of patients with an identified pathogen with those of patients without an identified agent.
Results:
The causative organism was identified in 74 patients (76.3%). Patients with microbiological diagnosis were younger, and a larger percentage of them exhibited elevated C-reactive protein value; however, they were not different from those without an identified agent in terms of sex, site of infection, comorbidities, and the presence of a concomitant infection. Our study could not demonstrate different neurological outcomes, length of stay, or mortality rates among the 2 groups.
Conclusions:
In a large series of patients with PSI, we did not demonstrate differences in clinical outcomes using empirical antibiotics in patients without an identified pathogen compared with patients with an identified microbiological agent receiving specific antibiotics. Future prospective multicenter studies should be conducted to obtain an answer to this important clinical question.
Insights
This study found no significant differences in clinical outcomes for pyogenic spinal infections (PSI) between patients treated with empirical antibiotics and those with identified pathogens receiving specific antibiotics. Further research is recommended.
Area of Science:
- Infectious Diseases
- Spinal Surgery
- Clinical Outcomes Research
Background:
- Pyogenic spinal infections (PSI) pose significant morbidity and mortality risks.
- Effective treatment often relies on specific antibiotics, yet many PSI cases are treated empirically without identified pathogens.
- Limited data exists comparing outcomes between these two treatment approaches.
Purpose of the Study:
- To compare clinical outcomes in patients with pyogenic spinal infections (PSI).
- To evaluate differences between patients with identified microbiological agents versus those without.
- To assess the impact of pathogen identification on treatment efficacy.
Main Methods:
- Retrospective review of 97 consecutive patients diagnosed with PSI over 14 years.
- Data collected included demographics, causative agent, comorbidities, infection site, inflammatory markers, neurological status, hospital stay, and mortality.
- Clinical outcomes were compared between patients with and without identified pathogens.
Main Results:
- A causative organism was identified in 76.3% of patients.
- Patients with identified pathogens were younger and more likely to have elevated C-reactive protein.
- No significant differences were observed in neurological outcomes, length of stay, or mortality rates between the two groups.
Conclusions:
- Empirical antibiotic treatment for PSI in patients without identified pathogens yielded similar clinical outcomes to specific antibiotics in patients with identified pathogens.
- The study did not demonstrate a difference in outcomes based on pathogen identification.
- Prospective, multicenter studies are needed to confirm these findings.
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