Haykır Solay Aslı, Bulut Dilek, Kul Gülnur, Kuzi Semanur, Emrahoğlu Muhammed Erkan, Süer Doğan İhsaniye, Korkmaz Nesibe, Soykuvvet Ayhan Ayşenur, Şanlı Fatma, Kavcar Mustafa, Öztürk Saffet, Çiçek Şentürk Gönül
Department of Infectious Diseases and Clinical Microbiology, Etlik City Hospital, 06170 Ankara, Türkiye.
Department of Neurosurgery, Etlik City Hospital, 06170 Ankara, Türkiye.
Medicina (Kaunas). 2025 Sep 3;61(9):1591. doi: 10.3390/medicina61091591.
: Pyogenic spondylodiscitis (SD) is a severe spinal infection involving the intervertebral disc and adjacent vertebrae and is often associated with significant morbidity. Identifying the causative microorganism is crucial for targeted treatment; however, the microbiological yield from blood or tissue cultures varies widely due to factors such as prior antibiotic use and biopsy technique. In this study, we aimed to investigate the clinical, laboratory, and radiological predictors of microbiological yield, particularly from tissue biopsy specimens. : This retrospective cohort study included adult patients diagnosed with pyogenic SD between January 2023 and July 2025 at a tertiary care hospital. Demographics, comorbidities, laboratory markers (CRP, ESR, ALP, albumin), radiological findings (abscess presence, anatomical location, claw sign), prior antibiotic use, and microbiological results were analyzed. Tissue specimens were obtained through either surgical sampling or needle biopsy. Univariable and multivariable logistic regression were performed to determine the predictors of positive tissue cultures. : Of the 159 patients screened, 55 met our inclusion criteria. The mean age was 63.9 ± 13.5 years, 80% had lumbar involvement, and 58.2% had abscesses, primarily paravertebral or psoas in location. Microorganisms were isolated in 65.5% of the cases, with Staphylococcus aureus being the most common (41.7%). The blood culture positivity was 55.5%, while tissue culture positivity was 40.4%. Logistic regression revealed that lower albumin ( = 0.046) and higher ALP levels ( = 0.045) were independent predictors of a positive microbial yield from tissue biopsies. : Serum albumin and ALP levels may aid clinical decision-making regarding invasive sampling in SD. When blood cultures are negative and albumin is low while ALP is elevated, clinicians should consider prioritizing tissue biopsy. These findings may help optimize diagnostic strategies and should be validated in larger, prospective studies.
化脓性脊椎椎间盘炎（SD）是一种严重的脊柱感染，累及椎间盘和相邻椎体，常伴有严重的发病率。确定致病微生物对于靶向治疗至关重要；然而，由于先前使用抗生素和活检技术等因素，血液或组织培养的微生物检出率差异很大。在本研究中，我们旨在调查微生物检出率的临床、实验室和影像学预测因素，特别是来自组织活检标本的预测因素。
这项回顾性队列研究纳入了2023年1月至2025年7月在一家三级护理医院被诊断为化脓性SD的成年患者。分析了人口统计学、合并症、实验室指标（CRP、ESR、ALP、白蛋白）、影像学表现（脓肿存在、解剖位置、爪征）、先前使用抗生素情况和微生物学结果。组织标本通过手术取样或针吸活检获得。进行单变量和多变量逻辑回归以确定阳性组织培养的预测因素。
在筛选的159例患者中，55例符合纳入标准。平均年龄为63.9±13.5岁，80%累及腰椎，58.2%有脓肿，主要位于椎旁或腰大肌。65.5%的病例分离出微生物，其中金黄色葡萄球菌最为常见（41.7%）。血培养阳性率为55.5%，组织培养阳性率为40.4%。逻辑回归显示，较低的白蛋白水平（P = 0.046）和较高的ALP水平（P = 0.045）是组织活检微生物阳性检出率的独立预测因素。
血清白蛋白和ALP水平可能有助于SD侵袭性采样的临床决策。当血培养阴性且白蛋白低而ALP升高时，临床医生应考虑优先进行组织活检。这些发现可能有助于优化诊断策略，应在更大规模的前瞻性研究中进行验证。
