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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
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[1] Chang-cheng MA,Zhen-yu WANG,Guo-zhong LIN. Diagnosis and treatment of primary intraspinal abscess [J]. Journal of Peking University (Health Sciences), 2020, 52(2): 275-280.
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