감염성 척추염의 임상양상 및 예후 인자에 관한 연구
Analysis of the Clinical Characteristics and Prognostic Factors of Infectious Spondylitis
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Background: Infectious spondylitis (IS) is a rare infectious disorder, which is often associated with significant neurologic deficits and mortality. However, previous domestic studies, have paid more attention to the differential diagnosis between pyogenic spondylitis (PS) and tuberculous spondylitis (TS) rather than to the treatment and outcomes of them. The aims of this study were to determine the clinical manifestations and outcomes of IS and to determine its prognostic factors. Materials and Methods: We compared the predisposing factors or associated illnesses and the clinical, radiological and laboratory features of the microbiologically confirmed cases of PS and TS in a tertiary hospital from January 2004to December 2009. We also analyzed the treatment outcomes and prognostic factors. Results: Of the 116 patients (78 males and 38 females), 93 (39 definite and 54 possible cases) had PS and 23 patients had TS. The patients with PS had a significantly higher rate of fever and higher levels of a WBC, CRP and ESR at the initial presentation than did the TS patients (P<0.05). TS was frequently associated with active tuberculosis of other organs and involvement of thoracic vertebral lesions. Among the 116 cases, 104 cases (83 PS cases, 21 TS cases) had followedup. The mean duration of intravenous antibiotics treatment was 6.3 weeks (range:0.8-16.0) for the PS patients, and the mean duration of anti-tuberculosis treatment was 36.0 weeks (range: 1.3-81.4 weeks) in the TS patients The proportion of favorable outcomes (complete recovery) was 34% and the proportion of poor ones was 66% (partial recovery with sequelae [60%] and death [6%]). The poor outcome of IS were independently associated with an age >65 years (OR=3.88,95% CI=1.28-11.71, P=0.016) and an initial presentation of neurologic deficits (OR=8.69, 95% CI= 2.86-26.39, P<0.001). Conclusions: The prognosis of the patients with IS was poor with partial recovery and sequelae in 60% of the patients and the mortality was 6%. The optimal treatment consisting of antibiotics and surgical treatment was needed to prevent poor outcomes of IS, and especially for the patients with an age >65 years and who displayed neurologic deficits at the initial presentation.
Abstract
Background: Infectious spondylitis (IS) is a rare infectious disorder, which is often associated with significant neurologic deficits and mortality. However, previous domestic studies, have paid more attention to the differential diagnosis between pyogenic spondylitis (PS) and tuberculous spondylitis (TS) rather than to the treatment and outcomes of them. The aims of this study were to determine the clinical manifestations and outcomes of IS and to determine its prognostic factors. Materials and Methods: We compared the predisposing factors or associated illnesses and the clinical, radiological and laboratory features of the microbiologically confirmed cases of PS and TS in a tertiary hospital from January 2004to December 2009. We also analyzed the treatment outcomes and prognostic factors. Results: Of the 116 patients (78 males and 38 females), 93 (39 definite and 54 possible cases) had PS and 23 patients had TS. The patients with PS had a significantly higher rate of fever and higher levels of a WBC, CRP and ESR at the initial presentation than did the TS patients (P<0.05). TS was frequently associated with active tuberculosis of other organs and involvement of thoracic vertebral lesions. Among the 116 cases, 104 cases (83 PS cases, 21 TS cases) had followedup. The mean duration of intravenous antibiotics treatment was 6.3 weeks (range:0.8-16.0) for the PS patients, and the mean duration of anti-tuberculosis treatment was 36.0 weeks (range: 1.3-81.4 weeks) in the TS patients The proportion of favorable outcomes (complete recovery) was 34% and the proportion of poor ones was 66% (partial recovery with sequelae [60%] and death [6%]). The poor outcome of IS were independently associated with an age >65 years (OR=3.88,95% CI=1.28-11.71, P=0.016) and an initial presentation of neurologic deficits (OR=8.69, 95% CI= 2.86-26.39, P<0.001). Conclusions: The prognosis of the patients with IS was poor with partial recovery and sequelae in 60% of the patients and the mortality was 6%. The optimal treatment consisting of antibiotics and surgical treatment was needed to prevent poor outcomes of IS, and especially for the patients with an age >65 years and who displayed neurologic deficits at the initial presentation.
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