S Amadoru1,2, K Lim1,3, M Tacey4,5, C Aboltins6,7. 1. Department of Geriatric Medicine, Northern Health, Melbourne, Victoria, Australia. 2. Department of Geriatric Medicine, Alfred Health, Melbourne, Victoria, Australia. 3. Department of Geriatric Medicine, Melbourne Health, Melbourne, Victoria, Australia. 4. Northern Centre for Health Education and Research (NCHER), Northern Health, Melbourne, Victoria, Australia. 5. Melbourne EpiCentre, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia. 6. Department of Infectious Diseases, Northern Health, Melbourne, Victoria, Australia. 7. North West Academic Centre, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Clinical features of infection can become more atypical as we age. Spinal infections can be insidious, and timely diagnosis and treatment are essential to prevent adverse outcomes. AIMS: To explore differences in presentation and outcomes between younger and older patients with bacterial spinal infections. METHODS: Clinical, microbiological and radiological information was collected for patients with spinal infections (spondylodiscitis, vertebral osteomyelitis, septic discitis, facet joint septic arthritis and spinal epidural abscess) at a single metropolitan hospital between January 2008 and January 2015. Patients were excluded if they were under 18 years of age or if clinical and imaging findings were inconsistent with the diagnosis. Presenting features, investigations and outcomes were compared for patients ≥65 (older) or <65 (younger) years old. RESULTS: Of 53 identified patients, 34 (64%) were classified as older, with more males in both older (65%) and younger (79%) groups. Older patients presented later (median symptom duration 13 vs 4 days, P = 0.016). Back pain was nearly ubiquitous. Older patients presented less commonly with fevers (38 vs 63%) and rigors (24 vs 42%) but more commonly with hypotension (18 vs 5%), delirium (24 vs 11%), higher median inflammatory marker levels and variable microbiological findings, although these differences were not statistically significant. They had longer median lengths of stay (24 vs 14 days) and a higher likelihood of death or failure of medical treatment (HR 9.34, P = 0.031). Radicular pain was associated with poor outcome (HR 3.29, P = 0.046). CONCLUSION: Older patients with spinal infections present later, with higher inflammatory markers and fewer typical infective symptoms and signs; these may contribute to poorer outcomes. A low threshold for promptly investigating older patients with new or worsening back pain should be set.
BACKGROUND: Clinical features of infection can become more atypical as we age. Spinal infections can be insidious, and timely diagnosis and treatment are essential to prevent adverse outcomes. AIMS: To explore differences in presentation and outcomes between younger and older patients with bacterial spinal infections. METHODS: Clinical, microbiological and radiological information was collected for patients with spinal infections (spondylodiscitis, vertebral osteomyelitis, septic discitis, facet joint septic arthritis and spinal epidural abscess) at a single metropolitan hospital between January 2008 and January 2015. Patients were excluded if they were under 18 years of age or if clinical and imaging findings were inconsistent with the diagnosis. Presenting features, investigations and outcomes were compared for patients ≥65 (older) or <65 (younger) years old. RESULTS: Of 53 identified patients, 34 (64%) were classified as older, with more males in both older (65%) and younger (79%) groups. Older patients presented later (median symptom duration 13 vs 4 days, P = 0.016). Back pain was nearly ubiquitous. Older patients presented less commonly with fevers (38 vs 63%) and rigors (24 vs 42%) but more commonly with hypotension (18 vs 5%), delirium (24 vs 11%), higher median inflammatory marker levels and variable microbiological findings, although these differences were not statistically significant. They had longer median lengths of stay (24 vs 14 days) and a higher likelihood of death or failure of medical treatment (HR 9.34, P = 0.031). Radicular pain was associated with poor outcome (HR 3.29, P = 0.046). CONCLUSION: Older patients with spinal infections present later, with higher inflammatory markers and fewer typical infective symptoms and signs; these may contribute to poorer outcomes. A low threshold for promptly investigating older patients with new or worsening back pain should be set.
Authors: Zachary Tuvya Sharfman; Yaroslav Gelfand; Pryiam Shah; Ari Jacob Holtzman; Joseph Roy Mendelis; Merritt Drew Kinon; Jonathan David Krystal; Allan Brook; Reza Yassari; David Claude Kramer Journal: Asian Spine J Date: 2020-07-29
Authors: Andreas F Mavrogenis; Panayiotis D Megaloikonomos; Vasileios G Igoumenou; Georgios N Panagopoulos; Efthymia Giannitsioti; Antonios Papadopoulos; Panayiotis J Papagelopoulos Journal: EFORT Open Rev Date: 2017-11-15