Conti Jacopo, Geremia Nicholas, Di Bella Stefano, Zadra Fulvio, Zerbato Verena, Babich Stella, Costantino Venera, Di Santolo Manuela, Busetti Marina, Mearelli Filippo, Tacconi Leonello, Cavallaro Marco Francesco Maria, Cova Maria Assunta, Biolo Gianni, Luzzati Roberto, Giacomazzi Donatella
AOU Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, Modena, 41121, Italy.
Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale dell'Angelo, Venice, 30174, Italy.
Eur J Clin Microbiol Infect Dis. 2025 Sep 29. doi: 10.1007/s10096-025-05292-5.
To describe the epidemiology, diagnosis, microbiological findings, clinical features, and outcomes of infectious spondylodiscitis (IS).
Retrospective analysis of 98 IS patients (2010-2023 - Trieste Hospital). Clinical, radiological, and microbiological data analysed, multivariate logistic regression assessed risk factors for poor outcomes.
The incidence of IS was 3 cases per 100,000 inhabitants per year. Pyogenic infections accounted for 54% of cases, tuberculosis for 10%, while 35% remained of unknown etiology. Back pain (79%) and fever (72%) were the most common symptoms. Staphylococcus aureus was the most common pathogen, with 34 cases, representing 64% of pyogenic spondylodiscitis. Blood cultures were positive in 47% of pyogenic cases, 25% of all cases. PET/CT showed higher diagnostic utility (83%) than labeled leukocyte scintigraphy (54%). The lumbar spine was the most affected region (63%), followed by thoracic (25%) and cervical (12%). Neurosurgical biopsy showed a 33.3% positivity rate, while CT-guided biopsy yielded 22%. Cervical (OR 4.76) and thoracic (OR 3.89) involvement were associated with worse outcomes. Major complications included radicular nerve damage (51%), epidural/paravertebral abscesses (45%), endocarditis (14%), and a need for surgical intervention in 8%, with persistent neurological sequelae in 3%. Infection-related mortality rate was 6%.
S. aureus remains the leading pathogen in IS. Blood cultures play a key role, yielding positive in half of pyogenic cases. PET/CT surpassed leukocyte scintigraphy and improved MRI diagnostic accuracy. Lumbar involvement correlates with better outcomes, and open biopsy provides a higher diagnostic yield than percutaneous TC-guided biopsy. Empirical therapy is required in one-third of cases.
