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Updated: Jun 20, 2026
Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis
Published on: May 23, 2021
Timely surgery and time to culture positivity: prognostic indicators in Staphylococcus-related pyogenic
Cheng-Min Hsu1, Yung-Hsueh Hu2, Yu-Cheng Yeh2
1Department of Orthopaedic Surgery, Division of Paediatric Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan.
Background Context:
Time to culture positivity (TTP) is a recognized surrogate for bacterial load and virulence in bloodstream infections; however, its prognostic utility using intraoperative tissue cultures in pyogenic spondylodiscitis remains undefined. Furthermore, the optimal surgical window in this context remains to be established.
Purpose:
This study aims to determine the prognostic value of TTP and identify the optimal surgical timing in patients with de novo Staphylococcus-related pyogenic spondylodiscitis.
Study Design/ Setting:
Retrospective cohort study in a tertiary referral medical center.
Patient Sample:
A total of 48 consecutive patients treated surgically for de novo Staphylococcus-related pyogenic spondylodiscitis between 2015 and 2021 (mean age: 61.8 years).
Outcome Measures:
The primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Recurrence was defined as the need for revision surgery due to recurrent spondylodiscitis following the completion of antibiotic therapy.
Methods:
Univariate and multivariate Cox regression analyses were performed to identify predictors of primary outcomes. Optimal cut-off values for TTP and surgical timing were analyzed to maximize prognostic discrimination.
Results:
The 1-year OS and RFS were 76% and 58%, respectively. A prolonged TTP (≥ 60 hours) and timely surgery (≤14 days) were associated with improved outcomes, demonstrating significantly better OS (HR: 0.18, p=.003; HR: 0.22, p=.019) and RFS (HR: 0.27, p=.003; HR: 0.35, p=.024).
Conclusions:
In this cohort, timely surgery (within 14 days) and prolonged TTP (more than 60 hours) were associated with improved overall and recurrence-free survival. These findings suggest that integrating specific surgical timeframes and bacterial growth characteristics may enhance risk stratification and guide management in Staphylococcus-related pyogenic spondylodiscitis.
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