Etiologic spectrum and diagnostic gaps of spinal infections: a cross-sectional study in Qingdao, China

Spinal infections drive global morbidity; however, accurate pathogen detection remains poor. We aimed to profile pathogens in local patients with spinal infections and assess pre-referral identification rates for different spinal infections.

This retrospective, cross-sectional study was conducted at a tertiary referral center in Qingdao, China, among adult patients with spinal infections admitted between December 2012 and December 2024. After approval from the relevant ethics committee, data were extracted from 181 culture-positive patients. Demographics, clinical features, history, and diagnostic methods were reviewed; infections were classified; and accurate pathogen identification rates were calculated.

Among the 181 participants, pyogenic spondylitis, brucellar spondylitis, tuberculous spondylitis, and fungal spondylitis accounted for 44.20 %, 35.91 %, 15.47 %, and 4.42 %, respectively. After excluding 64 patients initially diagnosed at our hospital, pre-referral accuracies were 12.50 %, 0 %, 9.76 %, and 25.00 % for pyogenic spondylitis, tuberculous spondylitis, brucellar spondylitis, and fungal spondylitis, respectively. The predominant pyogenic organisms identified were Escherichia coli, Staphylococcus aureus, other Staphylococcus spp., Klebsiella pneumoniae, Streptococcus gallolyticus, Bacteroides fragilis, and Enterococcus faecium. Aspergillus accounted for 75.00 % of fungal cases.

Delays exist in pathogen detection in spinal infections, highlighting the urgency need to improve conventional microbiological techniques and raise clinical awareness.