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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (6): 1042-1047. doi: 10.19723/j.issn.1671-167X.2019.06.011

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Analysis of influencing factors for pathogen culture result in patients with pyogenic spondylitis

Yun-peng CUI,Chuan MI,Bing WANG,Yuan-xing PAN,Yun-fei LIN,Xue-dong SHI()   

  1. Department of Orthopaedics, Peking University First Hospital, Beijing 100034, China
  • Received:2017-10-09 Online:2019-12-18 Published:2019-12-19
  • Contact: Xue-dong SHI E-mail:992516215@qq.com

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Abstract:

Objective: To investigate the effect of clinical factors on the pathogen culture results in the patients with pyogenic spondylitis, and to find out clinical controllable factors which could increase the positive rate of the pathogen culture.Methods: A retrospective study reviewed 40 patients who were diagnosed with pyogenic spondylitis in Peking University First Hospital from January 2011 to July 2017. The patients were divided into two groups depending on the culture results, culture negative or culture positive. The influence of clinical uncontrollable factors [the patient’s age, gender, predisposing factors, infection site except spine, visual analogue score (VAS), course of disease, spinal segment, white blood cell (WBC), (neutrophilic granulocyte)% (NE%), the incidence of systemic inflammatory response syndrome (SIRS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the incidence of paravertebral abscess] and controllable factors (prior antibiotics exposure within 2 weeks, tissue homogenate, surgical approach) on pathogen culture results were analyzed.Results: Of the 40 patients, 18 patients were female and 22 patients were male. Causative germ was identified in 24/40 patients (60.00%) and dominant by gram positive cocci (68.00%). For clinical uncontrollable factors, there was no significant difference between the two groups in the patient’s age, gender, predisposing factors, infection site except spine, VAS, course of disease, spinal segment, WBC, NE% and the incidence of SIRS. ESR [(94.38±6.91) mm/h, P=0.023)], CRP [(64.74±13.51) mg/L, P=0.040], and the incidence of paravertebral abscess (75%, P=0.018) in culture negative group were lower in contrast to culture positive group. For clinical controllable factors, prior antibiotics exposure within 2 weeks (P=0.058, OR=4.030, 95%CI: 0.956-16.993) and tissue homogenate (P=0.014, OR=0.171, 95%CI: 0.042-0.695) were significantly associated with the pathogen culture result. Surgical approach was not significantly associated with pathogen culture result.Conclusion: Patients with high level of ESR, CRP, and paravertebral abscess, would have high positive rate of pathogenic culture. Prior antibiotics exposure was associated with lower positive pathogen culture rate. Culture with tissue homogenate was more likely to find the causative germ, especially for patients without paravertebral abscess who had low level of ESR, CRP and prior antibiotics exposure.

Key words: Pyogenic spondylitis, Tissue homogenate, Antibiotics, Pathogen culture

CLC Number: 

  • R681.5

Table 1

Uncontrollable factors of patients with pyogenic spondylitis"

Items Culture - (n=16) Culture + (n=24) Statistic value P
General
Age/years 55.81±3.95 59.13±2.22 t=0.786 0.436
Female, n 8 10 Pa=0.269 0.604
Infection site except spine, n 2 3 Pb<0.001 1.000
Predisposing factors (DM, oral immunosuppressive agents), n 4 9 Pa=0.684 0.408
Clinical manifestation
Course of disease/d 60 (7, 270) 50 (7, 240) Z=-0.014 0.989
Temperature, n Z=-0.144 0.902
<37.5 ℃ 10 15
37.5-38.5 ℃ 3 3
>38.5 ℃ 3 6
SIRS, n 2 9 Pb=1.886 0.170
Laboratory examination
WBC/(×109/L) 8.14±0.62 7.84±0.85 t=-0.258 0.798
NE% 67.06±3.26 74.30±2.55 t=1.765 0.086
CRP/(mg/L) 213.0 (93.1, 793.0) 410.0 (59.8, 2 060.0) Z=-2.058 0.040
ESR/(mm/h) 65.00 (12.00, 124.00) 106.00 (36.00, 135.00) Z=-2.269 0.023
Imaging examination, n
Spinal segment Pa=0.269 0.182
Cervical and thoracic 8 7
Lumbar 8 17
Multiple segment involvement 2 5 Pb=0.065 0.799
Epidural abscess 4 4 Pb=0.059 0.809
Paravertebral abscess 6 18 Pa=5.625 0.018

Table 2

Antibiotic susceptibilities of culture positive patients with pyogenic spondylitis"

Pathogen culture result (n) Cipro Moxi Levo Cef R Oxa Vanco Carba
CN-S (1) - - - - - - - -
S. warneri (2) 0 0 0 - 0 1/2 0 -
S. cohnii urealyticum (1) 0 0 0 - 0 1/1 0 -
S. caprae (1) 0 0 0 - 0 0 0 -
S. hominis (1) 0 0 0 - 0 1/1 0 -
S. aureus (7) 1/7 0 0 - 0 2/7 0 -
Streptococcus (1) - - - - - - 0 -
S. agalactiae B group (2) - 1/2 1/2 - - - 0 -
E. gallinarum (1) 0 - 0 - - - 0 -
S. typhi (1) 0 - 0 0 - - - -
E. coli (3) 3/3 - 2/3 1/3 - - - 0
P. aeruginosa (1) 0 - 0 0 - - - 1/1
A. Baumanii (1) 1/1 - 1/1 1/1 - - - 1/1
M. luteus (1) - - - - - - - -
F. nucleatum (1) - - - - - - - -

Table 3

Controllable factors that may influence culture result"

Items Culture - (n=30) Culture + (n=25) Statistic value P
Procedure Pb=0.550 0.458
Debridement 15 (60.00%) 10 (40.00%)
Aspiration 15 (50.00%) 15 (50.00%)
Prior antibiotics history (within 2 weeks) Pb=1.872 0.171
Yes 21 (61.76%) 13 (38.24%)
No 9 (42.86%) 12 (57.14%)
Tissue homogenate Pb=3.669 0.055
Yes 7 (36.84%) 12 (63.16%)
No 23 (63.89%) 13 (36.11%)

Table 4

Logistic regression analysis of association between culture result and controllable factors"

Items Univariate analysis Multivariate analysis
P OR 95%CI P OR 95%CI
Aspiration 0.459 0.667 0.228-1.950 0.717 0.790 0.220-2.834
Prior antibiotics history (within 2 weeks) 0.174 2.154 0.712-6.516 0.058 4.030 0.956-16.993
Tissue homogenate 0.059 0.330 0.104-1.045 0.014 0.171 0.042-0.695
[1] Mylona E, Samarkos M, Kakalou E , et al. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics[J]. Semin Arthritis Rheum, 2009,39(1):10-17.
[2] Cheung WY, Luk KD . Pyogenic spondylitis[J]. Int Orthop, 2012,36(2):397-404.
[3] Sehn JK, Gilula LA . Percutaneous needle biopsy in diagnosis and identification of causative organisms in cases of suspected vertebral osteomyelitis[J]. Eur J Radiol, 2012,81(5):940-946.
[4] Sung S, Kwon JW . Image-guided percutaneous needle biopsy for infectious spondylitis: factors affecting culture positivity[J]. Cheminform, 2015,73(5):631-635.
[5] Hassoun A, Taur Y, Singer C . Evaluation of thin needle aspiration biopsy in the diagnosis and management of vertebral osteomyelitis (VO)[J]. Int J Infect Dis, 2006,10(6):486-487.
[6] Heyer CM, Brus LJ, Peters SA , et al. Efficacy of CT-guided biopsies of the spine in patients with spondylitis— an analysis of 164 procedures[J]. Eur J Radiol, 2012,81(3):e244-e249.
[7] Kim BJ, Lee JW, Kim SJ , et al. Diagnostic yield of fluoroscopy-guided biopsy for infectious spondylitis[J]. AJNR Am J Neuroradiol, 2013,34(1):233-238.
[8] Lucas EMD, Mandly AG, Gutiérrez A , et al. CT-guided fine-needle aspiration in vertebral osteomyelitis: true usefulness of a common practice[J]. Clin Rheumatol, 2009,28(3):315-320.
[9] 吴强, 王金龙, 邵增务 , 等. CT引导经皮穿刺骨活检在非典型脊柱感染性病变诊断中的价值[J]. 中国脊柱脊髓杂志, 2017,27(3):280-282.
[10] Huang R, Hu CC, Adeli B , et al. Culture-negative periprosthetic joint infection does not preclude infection control[J]. Clin Orthop Relat Res, 2012,470(10):2717-2723.
[11] Parvizi J, Erkocak OF, Della Valle CJ . Culture-negative periprosthetic joint infection[J]. J Bone Joint Surg Am, 2014,96(5):430-436.
[12] Choi HR, Kwon YM, Freiberg AA , et al. Periprosthetic joint infection with negative culture results: clinical characteristics and treatment outcome[J]. J Arthroplasty, 2013,28(6):899-903.
[13] 唐旭, 王启, 王辉 , 等. 人工关节置换术后假体周围感染诊断方法的比较与评价[J]. 中华外科杂志, 2016,54(4):251-257.
[14] 张宁, 赵翔, 周鑫叠 , 等. 关节液与组织培养在髋膝关节置换术后感染诊断价值的Meta分析[J]. 中华关节外科杂志: 电子版, 2014,8(1):56-59.
[15] Marschall J, Bhavan KP, Olsen MA , et al. The impact of pre-biopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis[J]. Clin Infect Dis, 2011,52(7):867-872.
[16] Kim C J, Song K H, Park W B , et al. Microbiologically and clinically diagnosed vertebral osteomyelitis: impact of prior antibiotic exposure[J]. Antimicrob Agents Chemother, 2012,56(4):2122-2124.
[17] Wang YC, Wong CB, Wang IC , et al. Exposure of prebiopsy antibiotics influence bacteriological diagnosis and clinical outcomes in patients with infectious spondylitis[J]. Medicine, 2016,95(15):e3343.
[18] 崔云鹏, 米川, 施学东 , 等. 培养阴性化脓性脊柱炎患者的临床特征及预后[J]. 北京大学学报(医学版), 2017,49(2):226-230.
[19] 肖二辉, 宁会彬, 康谊 , 等. 231例脊柱感染患者的流行病学和临床特点[J]. 中华传染病杂志, 2016,34(5):263-266
[20] Kang SJ, Jang HC, Jung SI , et al. Clinical characteristics and risk factors of pyogenic spondylitis caused by gram-negative bacteria[J]. PLoS One, 2015,10(5):e0127126.
[21] Dong HK, Kim HS, Nam KH , et al. Adverse drug reactions of long-term intravenous antibiotics in patients with pyogenic spondylitis[J]. Korean J Spine, 2014,11(3):113-116.
[22] Kim CJ, Kang SJ, Choe PG , et al. Which tissues are best for microbiological diagnosis in patients with pyogenic vertebral osteomyelitis undergoing needle biopsy?[J]. Clin Microbiol Infect, 2015,21(10):931-935.
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