Patient selection
It is a prospective study done between 2013 and 2020. All patients’ data were anonymously used. This study was approved by the Research Review Committee and the Ethical Review Committee of the Affiliated Hospital of Qingdao University. Informed consents were obtained from the patients and prior to inclusion in the study.
The study included culture-negative group (n=126), culture Positive-group (n=76) with confirmed diagnosis of pyogenic spondylitis.
Data and definitions
Inclusion criteria: (1) age ≥ 18 years; (2) the patient's clinical symptoms and imaging examinations are consistent with spinal infection; (3) histopathological examinations suggest purulent inflammation; (4) blood culture and tissue culture bacteria are positive or negative. Exclusion criteria: (1) tuberculosis, brucella, fungus and other types of spinal infections; (2) previous spinal trauma, spinal puncture and spinal surgery history.
The data analyzed include age, gender, affected segment, spinal abscess, diabetes, course of disease, whether surgery, recurrence, admission ESR, admission CRP, admission WBC, discharge ESR, discharge CRP, ESR decline rate, CRP decline rate, hospital stay, Body temperature ≥38℃.
There is no standardized antibacterial therapy. Those with positive cultures should be treated with sensitive antibiotics by drug sensitivity test, and those with negative cultures should be treated with antibiotics with broad antimicrobial spectrum. The outcome is divided into treatment success and relapse. Criteria for successful treatment: (1) Inflammation indicators (ESR, CRP) are controlled within the normal range and body temperature is normal; (2) Tissue bacterial culture is negative; (3) There is no evidence of spinal infection. The criteria for relapse are: (1) After the initial improvement, the clinical symptoms and inflammatory indicators (ESR, CRP) re-appear; (2) After the treatment is completed, the clinical symptoms, imaging and bacteriological examinations consistent with pyogenic spondylitis appear again.
Statistical Analysis
The data results were analyzed with SPSS 20.0 statistical software. The measurement data were expressed by the mean standard deviation. When the two groups of data met the normal distribution and the homogeneity of variance, the Student t test was used, and the Mann-Whitney U rank sum test was used when the conditions were not met. Categorical variables used chi-square test, multi-categorical variables used row-multiplied list chi-square test, fisher exact test was used when the conditions of chi-square test were not met, and Mann-Whitney U rank sum test was used for ordinal categorical variables. For the risk factors with significant differences in univariate analysis, the binary logistic regression model was used to analyze. P<0.05 was considered statistically significant (two-sided test).
Demographics and clinical characteristics
A total of 453 patients with spinal infections were searched during the study. Among them, post-spine infection (n=46), spinal tuberculosis (n=114) and brucellosis spondylitis (n=75), spinal fungal infection (n=11), mixed spinal infection (n=5), total 251 cases. A total of 202 patients with purulent spondylitis were included in this study, of which 76 (37.62%) were culture positive. See Table 1. The culture-positive group involved 5 cases of cervical spine, 18 cases of thoracic spine, and 53 cases of lumbosacral spine. The culture-negative group involved 13 cases of cervical spine, 25 cases of thoracic spine, and 84 cases of lumbosacral spine. See Table 4.
Treatment process
Among the 202 patients in this group, 23 patients with epidural abscess were treated with emergency surgery. Tissue cultures were taken during the operation, and 16 cases were culture positive. The remaining 179 patients had complete blood cultures, and 20 were positive. The remaining 159 patients underwent CT-guided puncture of infected lesions under strict aseptic conditions, and 40 cases were positive. All patients were routinely given vancomycin + imipenem or vancomycin + fluoroquinolones or fluoroquinolones + third-generation cephalosporin antibiotics intravenously, strict bed rest, nutritional support and other conservative treatments. Those who are culture-positive should be treated with sensitive antibiotics based on the results of drug susceptibility, and those who are culture-negative will continue to be treated with broad-spectrum antibiotics, and antibiotics will be adjusted according to changes in the disease. The patient's body temperature, ESR, CRP, and WBC changes are monitored regularly. Indications for surgical treatment: Conservative treatment is ineffective, combined with spinal instability, impaired spinal cord nerve compression, and progressive symptoms. Indications for conservative treatment: conservative treatment is effective, no spinal instability, no spinal cord nerve compression damage, asymptomatic progressive aggravation, etc.