The impact of concomitant infective endocarditis in patients with spondylodiscitis and isolated spinal epidural empyema and the diagnostic accuracy of the modified Duke criteria
Mido Max Hijazi (Dresden), Timo Siepmann (Dresden), Ibrahim El-battrawy (Bochum), Assem Aweimer (Bochum), Percy Schröttner (Dresden), Martin Mirus (Dresden), Dino Podlesek (Dresden), Gabriele Schackert (Dresden), Tareq Juratli (Dresden), Ilker Y. Eyüpoglu (Dresden), Andreas Filis (Dresden)
The co-occurrence of infective endocarditis (IE) and primary spinal infections (PSI) such as spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE) represents a life-threatening infection that requires multidisciplinary management to be successful. Therefore, we aimed to characterize the clinical phenotypes of PSI patients with concomitant IE and evaluate the accuracy of the modified Duke criteria.
We conducted a retrospective cohort study comparing PSI patients with IE (PSICIE) and without IE (PSIWIE) who underwent surgery at our spine center between 2002 and 2022 to identify significant differences.
Methicillin-susceptible Staphylococcus aureus (MSSA) was the most common pathogen in PSICIE group (13 patients, 54.2 %) and aortic valve IE was the most common type of IE (12 patients, 50%). Hepatic cirrhosis (p < 0.011; OR: 4.383; 95% CI: 1.405 - 13.671), septic embolism (p < 0.005; OR: 4.387; 95% CI: 1.555 - 12.380), and infection with Streptococcus spp. and Enterococcus spp. (p < 0.003; OR: 13.830; 95% CI: 2.454 - 77.929) were identified as significant independent risk factors for the co-occurrence of IE and PSI in our cohort. The modified Duke criteria demonstrated a sensitivity of 100% and a specificity of 66.7% for the detection of IE in PSI patients. Pathogens were detected more frequently via blood cultures in the PSICIE group than in the PSIWIE group (PSICIE: 23, 95.8% vs. PSIWIE: 88, 62.4%, p < 0.001). Hepatic cirrhosis (PSICIE: 10, 41.7% vs. PSIWIE: 33, 21.6%, p = 0.042), pleural abscess (PSICIE: 9, 37.5% vs. PSIWIE: 25, 16.3%, p = 0.024), sepsis (PSICIE: 20, 83.3% vs. PSIWIE: 67, 43.8%, p < 0.001), septic embolism (PSICIE: 16/23, 69.6% vs. PSIWIE: 37/134, 27. 6%, p < 0.001) and meningism (PSICIE: 8/23, 34.8% vs. PSIWIE: 21/152, 13.8%, p = 0.030) occurred more frequently in PSICIE than in PSIWIE patients. PSICIE patients spent more time in the hospital than PSIWIE (PSICIE: 43.5 [33.5 - 53.5] days vs. PSIWIE: 31 [22 - 44] days, p = 0.003).
We report distinct clinical, radiological, and microbiological phenotypes in PSICIE and PSIWIE patients and further demonstrate the diagnostic accuracy of the modified Duke criteria in patients with PSI and concomitant IE. In the high-risk population of PSI patients, the modified Duke criteria might benefit from amending pleural abscess, meningism, and sepsis as minor criteria and hepatic cirrhosis as major criterion.
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