Kliniðimizde yatarak takip edilen spontan piyojenik spondilodiskit olgularýnýn retrospektif deðerlendirilmesi

Amaç: Spondilodiskit intervertebral diskin ve komþu vertebralarýn infeksiyonudur. Piyojenik spondilodiskit çoðunlukla spinal cerrahiyi takiben geliþir, spontan piyojenik spondilodiskit ise nadirdir. Spesifik bulgularýn yokluðu nedeni ile taný gecikmesi yüksek morbidite ve mortaliteye yol açabilir. Bu olgu serisinde beþ yýllýk periyotta kliniðimizde takip edilen spontan piyojenik spondilodiskit olgularýnýn klinik özellikleri, predispozan faktörler, tedavi ve sonuçlarýn deðerlendirilmesi amaçlandý.
Gereç ve Yöntem: 01.01.2007-31.12.2014 tarihleri arasýnda kliniðimizde takip edilen spontan piyojenik spondilodiskit tanýlý ardýþýk on üç hastanýn dosyasý retrospektif incelendi. Taný olgularýn klinik bulgularý, inflamasyonun laboratuar bulgularý olan beyaz küre sayýsý, eritrosit sedimentasyon hýzý, C-reaktif protein artýþý, kan ya da biyopsi kültür sonuçlarý ve taný ile uyumlu magnetik rezonans bulgularý ile konuldu. Olgularýn demografik özellikleri, özgeçmiþleri, predispozan faktörleri, laboratuar ve radyolojik veriler, üreyen mikroorganizmalar ve tedavi yanýtlarý deðerlendirildi.
Bulgular: Deðerlendirilen on üç hastanýn sekizi erkek, beþi kadýndý. Yaþlarý 19-87 arasýndaydý. (ortalama: 61) Bütün hastalar bel aðrýsý þikayeti ile baþvurmuþtu. Hastalarýn dokuzunda 38°C ve üzeri ateþ, dört hastada duyu kaybý, dört hastada kas güçsüzlüðü olmak üzere sekizinde nörolojik bulgular vardý. Diyabetes mellitus olgularýn dokuzunda bulunmaktaydý, bu olgularýn üçünde ise diyabetes mellitus kontrolsüzdü. Olgularýn üçü son dönem böbrek yetmezliði olup dialize girmekteydi. Taný öncesi semptom süresi 15-180 gün arasýnda deðiþmekteydi. En sýk etken S.aureus olarak belirlendi. Ýzole edilen S. aureus tümünde metisiline hassastý. Olgularýmýzdan birinde S. aureus menenjiti eþlik
etmekteydi. Etkilenen bölge sekiz olguda torakal, beþ olguda lomber vertebraydý. Etkeni MSSA olan olgularýn yedisinde sefazolin iv ile, menenjit eþlik eden olguda sefepim, bir olguda ise böbrek yetmezliði nedeniyle ampisilin sulbaktam ile tedaviye baþlandý. Etken olarak Enterococcus izole edilen olgulardan biri ampisilin sulbaktam, diðeri teikoplanin ile, Klebsiella spp izole edilen ise olgu levofloksasin ile tedavi edildi. Olgularýn dördüne cerrahi drenaj uygulandý. Tüm hastalarda tedaviye yanýt alýndý.
Sonuç: Spontan piyojenik spondilodiskit nadir bir hastalýktýr. Ancak akut ya da subakut belaðrýsý ile gelen her hastada, özellikle diyabetes mellitusu olan ya da ileri yaþta olan hastalarda düþünülmelidir. Erken taný, uygun medikal tedavi ve gerektiðinde cerrahi müdahale ile iyileþme oraný yüksektir.

Retrospective evaluation of spontaneous pyogenic sponydylodiscitis cases hospitalized in our clinic

Objective: Spondylodiscitis is the infection of the intervertebral disc and the adjacent vertebral bodies. Pyogenic Spondylodiscitis often develops following spinal surgery, spontaneous pyogenic spondylodiscitis is rare. Delay in diagnosis due to the absence of specific findings may lead to high morbidity and mortality. In this case series, we aimed to evaluate clinical features, predisposing factors, treatment and results of patients with spontaneous spondylodiscitis followed at our clinic within five years period.
Material and Method: Between 01.01.2007-31.12.2014, files of thirteen consecutive patients diagnosed with spontaneous pyogenic spondylodiscitis and hospitalized in our clinic were studied retrospectively. Diagnosis was based on clinical presentation, laboratory findings like increased white blood cell count, erythrocyte sedimentation rate, C-reactive protein as an evidence of inflammation and also blood or biopsy culture results and magnetic resonance imaging findings consistent with the diagnosis. The demographic characteristics, history, predisposing factors, laboratory and radiological data, microorganism and treatment response of patients were evaluated.
Results: Among the patients eight were male and five female. Ages ranged between 19-87. (Mean: 61) All patients suffered from back pain. Nine patients had fever higher than 38°C, and eight patients had a nerve root compression. There were nine cases with diabetes mellitus, and three of these patients had uncontrolled diabetes mellitus. Three of the patients had end-stage renal disease undergoing dialysis. Duration of symptoms before establishing the diagnosis ranged between 15-180 days. S. aureus was the most common isolated microorganism. All S. aureus isolates were methicillin-sensitive. One of our cases was accompanied by S. aureus meningitis. The affected areas in eight cases were thoracic and and in five cases lumbar vertebra. Treatment was cefazolin in seven patients with MSSA, cefepime in patients with concomitant meningitis and ampicillin sulbactam in one patient with renal failure. One of the cases with isolated Enterococcus spp was treated with ampicillin sulbactam and one with teicoplanin. Patients with isolated Klebsiella spp were treated with levofloxacin. Four patients underwent surgical drainage. All patients responded to treatment.
Conclusion: Spontaneous pyogenic spondylodiscitis is a rare disease. However, in all patients with acute or subacute back pain the diagnosis should be considered particularly in patients with diabetes mellitus or advanced age. Early diagnosis is essential for high cure rate with appropriate medical treatment and surgical intervention if needed.