Spinal infection: an evolving clinical and public health challenge

Anecdotal and international evidence suggests an increasing incidence of spinal infection. Our primary aim was to assess the changing incidence and referral patterns for spinal infection at a quaternary public hospital neurosurgery unit. Our secondary aim was to analyze the clinical characteristics and service requirements of this patient population.

Data spanning 2013-2022 was derived from patient records at The Royal Melbourne Hospital, a quaternary public hospital and one of five adult public neurosurgical units in the state of Victoria, Australia. Logistic and negative binomial regression was used to examine trends.

Across the investigation period, 771 referrals for spinal infection were received, increasing by 13.2% per year (p < 0.001, 95% CI: 8.6-18.1), with the majority from areas of relative socioeconomic disadvantage. The incidence of spinal infection admissions per 10,000 hospital admissions rose by 4.7% per year (p = 0.004, 95% CI: 1.5-7.9). The annual mean number of risk factors per patient increased by 4.8% per year (p = 0.033, 95% CI: 0.4-9.5). Whilst Methicillin-sensitive Staphylococcus aureus (MSSA) was the most common causative organism cumulatively, the annual incidence of non-MSSA organisms increased by 13.1% per year (p = 0.015, 95% CI: 2.5-25.0). The annual mean duration of intravenous antibiotic treatment decreased by 11.5% per year (p < 0.001, 95% CI: 7.8-15.1). 341 surgeries were performed, and were positively correlated with the number of spinal infection admissions (p < 0.001).

Our observations confirm a significant rise in the incidence of spinal infection over 10 years, coupled with a changing landscape in patient profiles and treatment paradigms. Further studies are needed to better understand the impact and management of this growing disease burden.