Journal Article

Spondylodiscitis complicating infective endocarditis

Cammilleri, Serge, Drancourt, Michel, Gun, Mesut, Lieu, Audrey, Carbone, Andreina, Riberi, Alberto, Tessonnier, Laetitia, Philip, Mary, Casalta, Jean-Paul, Arregle, Florent, Santelli, Francesco, Peugnet, Fanny, Collart, Frederic, Martel, Hélène, Mouhat, Basile, Bohbot, Yohann, Gouriet, Frédérique, Guedj, Eric, Tribouilloy, Christophe, Delpierre, Quentin, Camoin-Jau, Laurence, Habib, Gilbert, Raoult, Didier, D'Andrea, Antonello

2020

Overview

ObjectiveThe primary objective was to assess the characteristics and prognosis of pyogenic spondylodiscitis (PS) in patients with infective endocarditis (IE). The secondary objectives were to assess the factors associated with occurrence of PS.MethodsProspective case–control bi-centre study of 1755 patients with definite IE with (n=150) or without (n=1605) PS. Clinical, microbiological and prognostic variables were recorded.ResultsPatients with PS were older (mean age 69.7±18 vs 66.2±14; p=0.004) and had more arterial hypertension (48% vs 34.5%; p<0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without PS. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L4–L5. Neurological symptoms were observed in 59% of patients. Enterococci and Streptococcus gallolyticus were more frequent (24% vs 12% and 24% vs 11%; p<0001, respectively) in the PS group. The diagnosis of PS was based on contrast-enhanced MRI in 92 patients, bone CT in 88 patients and 18F-FDG PET/CT in 56 patients. In-hospital (16% vs 13.5%, p=0.38) and 1-year (21% vs 22%, p=0.82) mortalities did not differ between patients with or without PS.ConclusionsPS is a frequent complication of IE (8.5% of IE), is observed in older hypertensive patients with enterococcal or S. gallolyticus IE, and has a similar prognosis than other forms of IE. Since PS is associated with specific management, multimodality imaging including MRI, CT and PET/CT should be used for early diagnosis of this complication of endocarditis.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system / [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases / [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases / [SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology / [SDV.MP.PAR] Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology / [SDV.MP.VIR] Life Sciences [q-bio]/Microbiology and Parasitology/Virology / Abscesses / Aged / Aged, 80 and over / Antibiotics / Autoimmune diseases / Bacteriology / Biopsy / cardiac imaging and diagnostic / cardiac imaging and diagnostics / cardiac imaging and diagnostics; endocarditis / Cardiology and cardiovascular system / Cardiovascular disease / Discitis / Embolisms / Emerging diseases / Endocarditis / Epidural / Female / Heart failure / Heart surgery / Human health and pathology / Humans / Hypertension / Infectious diseases / Life Sciences / Male / Medical prognosis / Microbiology and Parasitology / Middle Aged / Multimodal Imaging / Parasitology / Positron Emission Tomography Computed Tomography / Prognosis / Prospective Studies / Prostheses / Sepsis / Valvular heart disease / Vertebrae / Virology