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Diagnostic delay of pyogenic vertebral osteomyelitis and its associated factors

M Jean1, J-O Irisson2,3, G Gras4

  • 1a Infectious Diseases Department , University Hospital of Paris, CHU Raymond Poincaré, APHP, Garches Versailles Saint Quentin University , France.

Scandinavian Journal of Rheumatology
|April 22, 2016
PubMed
Abstract

Insights

Pyogenic vertebral osteomyelitis (PVO) diagnosis remains delayed despite advanced imaging. High C-reactive protein (CRP) levels significantly shorten diagnostic delay for PVO, aiding early detection of this rare spinal infection.

Area of Science:

  • Infectious Diseases
  • Orthopedics
  • Radiology

Background:

  • Pyogenic vertebral osteomyelitis (PVO) is a rare condition with potentially severe outcomes like sepsis and spinal cord injury.
  • Historically, diagnosing PVO involved significant delays due to non-specific symptoms and limited access to advanced imaging like MRI.
  • Understanding factors influencing diagnostic delay (DD) is crucial for timely PVO management.

Purpose of the Study:

  • To investigate the clinical spectrum of PVO.
  • To analyze the diagnostic delay (DD) in PVO cases.
  • To identify factors associated with prolonged or shortened DD in PVO.

Main Methods:

  • Prospective cohort study of 88 patients with microbiologically confirmed PVO.
  • Data collected between November 15, 2006, and November 15, 2010.
  • Analysis included univariate and multivariate assessments of patient demographics, clinical presentation, diagnostic tests, and DD.

Main Results:

  • The mean DD was 45.5 days, with Staphylococcus being the most common pathogen (51.1%).
  • High C-reactive protein (CRP) levels (> 63 mg/L) and positive blood cultures significantly reduced DD.
  • X-ray investigation was associated with a longer DD, while anti-inflammatory drug use did not impact DD or severity.

Conclusions:

  • Diagnostic delay for PVO persists despite improved MRI accessibility.
  • Elevated CRP levels serve as a valuable indicator for shortening PVO diagnostic delay.
  • Anti-inflammatory drugs do not appear to influence PVO diagnostic delay or disease severity at diagnosis.

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