S13.10 CLINICAL CHARACTERISTICS OF PATIENTS WITH INFECTIVE SPONDYLODISCITIS AND CONCOMITANT ENDOCARDITIS

Abstract

Aims: The aim of the study was to evaluate the clinical characteristics of patients with infective spondylodiscitis and concomitant endocarditis.

Methods: In the present study clinical features of patients with infective spondylodiscitis and endocarditis were compared to those without endocarditis. Case records of patients with infective spondylodiscitis treated at the Department of Infectious Diseases in Ljubljana in years 1991 to 2007 were reviewed. The following data were recorded: age, sex, underlying disease, previous or concomitant infections, previous operations, clinical features, causative agents, results of x-ray and other diagnostic examinations, complications and outcome of the disease. The Duke criteria were used for the diagnosis of endocarditis. The data were analysed using Epi Info 6 statistical programme. Patients with endocarditis were compared with others using Chi square, t-test and Mann-Whitney test.

Results: During the study period 149 patients with infective spondylodiscitis were diagnosed. There were 92 (61.7%) males and 57 (38.3%) females, aged 13 to 95 years, mean 61.0 ± 14 years. Eleven (7.0%) out of 149 patients with infective spondylodiscitis had concomitant endocarditis, two of them on prosthetic valves. The causative pathogen in patients with endocarditis was Staphylococcus aureus in seven (MRSA in two), mixed infection, Streptococcus viridans, Pseudomonas aeruginosa and coagulase negative staphylococci in one each. Staphylococcus aureus was the most common causative agent of infective spondylodiscitis. Among the three patients with MRSA spondylodiscitis, endocarditis was also present in two. Patients with concomitant endocarditis were similar to those without it but the two groups differed in mortality which was significantly higher in the group of patients with endocarditis (36% vs. 10%.; p < 0.05). In three patients (who died) spondylodiscitis presented at the same time as acute endocarditis and the clinical picture was predominantly that of severe endocarditis. In five patients (one of whom died) spondylodiscitis manifested late in the course of endocarditis and in one patient spondylodiscitis preceded endocarditis. In two patients endocarditis was diagnosed on routine echocardiography performed for staphylococcal sepsis. The urgent valve replacement was performed in two patients but was followed with relapse of endocarditis in one of them.

Conclusions: Although rarely, association of infective spondylodiscitis with endocarditis conveys a poor prognosis especially in the setting of acute staphylococcal endocarditis.