BACKGROUND CONTEXT: Spondylodiscitis management presents significant clinical challenges, particularly in critically ill patients, where the risks and benefits of surgical intervention must be carefully balanced. The optimal timing of surgery in this context remains a subject of debate. PURPOSE: This study aims to evaluate the effectiveness of early surgery versus delayed surgery or conservative management in critically ill patients with de novo pyogenic spondylodiscitis. STUDY DESIGN/SETTING: This is an international, multicenter retrospective cohort study involving 24 centers, primarily in Europe. PATIENT SAMPLE: The study included 192 critically ill patients (65.63% male) with a median age of 69 years, all severely affected by pyogenic spondylodiscitis characterized by an initial CRP level >200 mg/l or the presence of two out of four Systemic Inflammatory Response Syndrome criteria upon admission. OUTCOME MEASURES: The primary outcome was 30-day mortality. Secondary outcomes included length of ICU stay, length of hospital stay, and relapse rates of spondylodiscitis. METHODS: Patients were divided into three groups: early surgery (within three days of admission), delayed surgery (after three days of admission), and conservative therapy. Propensity score matching and multivariate regression analyses were performed to adjust for baseline differences and assess the impact of treatment modalities on mortality and other clinical outcomes. RESULTS: Delayed surgery was associated with significantly lower 30-day mortality (4.05%) compared to early surgery (27.85%) and conservative therapy (27.78%) (p<.001). Delayed surgery also resulted in shorter hospital stays (42.76 days) compared to conservative therapy (55.53 days) and early surgery (26.33 days) (p<.001), and shorter ICU stays (4.52 days) compared to conservative therapy (16.48 days) and early surgery (7.92 days) (p<.001). The optimal window for surgery, minimizing mortality, was identified as ten to fourteen days postadmission (p=.02). Risk factors for increased mortality included age (p<.05), multiple organ failure (p<.05), and vertebral body destruction (p<.05), whereas delayed surgery (p<.05) and the presence of an epidural abscess were associated with reduced mortality (p<.05). CONCLUSIONS: Delayed surgery, optimally between 10 to 14 days postadmission, was associated with lower mortality in critically ill spondylodiscitis patients. These findings highlight the potential benefits of considering surgical timing to improve patient outcomes.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• délka pobytu MeSH
• discitida * terapie   mortalita   chirurgie   mikrobiologie   MeSH
• konzervativní terapie MeSH
• kritický stav MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Symptomatické neurologické komplikácie sa vyskytujú u 15-30 % pacientov s infekčnou endokarditídou. Zároveň sa u 35-60 % pacientov vyskytujú klinicky nemé mozgové embólie. Staphylococcus aureus je patogén, ktorý najčastejšie spôsobuje postihnutie nervového systému. Uvádzame prípad 67-ročného muža s infekčnou endokarditídou po stomatologickom výkone, ktorý sa prejavil ako spondylodiscitída a mnohopočetná embolizácia do mozgu, vrátane mozgového abscesu, ktorý si vyžiadal neurochirurgickú drenáž. Po 6 týždňoch liečby širokospektrálnymi antibiotikami a komplexnej podpornej terapii sme pacienta prepustili v uspokojivom somatickom a psychickom stave. Pokračuje príprava pacienta na kardiochirurgický výkon.

Symptomatic neurological complications occur in 15-30% of patients with infective endocarditis. At the same time, other clinically silent cerebral embolisms occur in 35-60% of patients. Staphylococcus aureus is the pathogen that causes nervous system involvement most frequently. We report a case of a 67-year-old man with infective endocarditis following a dental procedure that manifested as spondylodiscitis and multiple brain embolization, including a brain abscess that required drainage. After six weeks of treatment with broad-spectrum antibiotics and complex supportive therapy, we discharged the patient in a satisfactory mental and somatic condition. The preparation of the patient for cardiac surgery is ongoing.

• MeSH
• absces mozku diagnostické zobrazování   etiologie   patologie   terapie   MeSH
• discitida diagnostické zobrazování   komplikace   patologie   MeSH
• echokardiografie transezofageální MeSH
• endokarditida * diagnostické zobrazování   farmakoterapie   komplikace   patologie   terapie   MeSH
• extrakce zubů škodlivé účinky   MeSH
• intrakraniální embolie * diagnostické zobrazování   komplikace   patologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mitrální insuficience diagnostické zobrazování   etiologie   farmakoterapie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• absces mozku * diagnóza   terapie   MeSH
• discitida diagnóza   terapie   MeSH
• lebka patologie   MeSH
• lidé MeSH
• meningitida bakteriální * etiologie   terapie   MeSH
• osteomyelitida diagnóza   etiologie   terapie   MeSH
• spondylartritida diagnóza   terapie   MeSH
• subdurální empyém * diagnóza   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

PURPOSE OF THE STUDY To describe epidemiological and clinical features of pyogenic spinal infections in patients treated at the Department of Infectious, Parasitic and Tropical Diseases of the Hospital Na Bulovce in 2010-2014, and to analyse a predictive significance of selected variables. MATERIAL AND METHODS A single-centre retrospective cohort study carried out from 1.1.2010 to 31.12.2014 enrolled adult patients with septic spondylitis, discitis and facet joint infections. Recorded parameters included: demographics, chronic comorbidities, time to diagnosis, radiological work-up, anatomical level of spinal infection, source of infection, etiological agent, complications, treatment and outcomes. RESULTS Fifty-four patients were enrolled, 35 men (65%) and 19 women (35%), age range 33-90, mean age 63 years. Forty patients (74.1%) had a chronic comorbidity, 20 patients (37%) were obese. Time to diagnosis ranged between 1-90 days, mean 16.3 days. The diagnosis was assessed with MRI in 41 (75.9%) and CT in 11 patients (20.4%). Lumbosacral spine was affected in 38 (70.4%), thoracic in 14 (25.5%), cervical in 8 patients (14.8%), and 6 patients (11.1%) had a multilevel disease. Epidural abscess developed in 28 (51.9%), paravertebral oedema or abscess in 41 patients (75.9%). Endocarditis was diagnosed in 8 patients (14.8%). Aetiology was identified in 45 patients (83.3%), with Staphylococcus aureus isolated in 29 patients (53.7%). Twenty-two patients (40.7%) were treated surgically in addition to antibiotics. The mean length of hospital stay, parenteral antibiotic treatment and total antibiotic treatment was 48.7, 38.2 and 71.5 days, respectively. Thirty-six patients (66.6%) recovered with no or mild sequelae, 7 (13%) with severe sequelae, and 11 patients (20.4%) died. None of the analysed variables proved to be a statistically significant predictive factor of clinical outcome. DISCUSSION In accordance with previous studies pyogenic spinal infections were diagnosed mainly in elderly with chronic internal comorbidities, mostly with magnetic resonance imaging, they were often localized in lumbar spine, with staphylococci being the leading agents. In spite of unavailable CT-navigated biopsy, the aetiology was discovered in majority of patients. In contrast, this study found a more frequent posterior segments involvement, a shorter time to treatment, no tuberculous cases, a relatively high case fatality ratio, but less sequelae and no relapse. CONCLUSIONS The study confirmed an increasing incidence of pyogenic spinal infections, known predisposing factors, importance of MRI in diagnostics, disease predilection in lumbar spine, staphylococcal predominance in causative pathogens, and a relatively high case fatality ratio. Although time to treatment was not proved to be a negative predictive factor of clinical outcome, it is an imperative to strive for an early diagnosis and treatment. Predictors of clinical outcome have to be evaluated in a more extensive cohort of patients. Key words: spinal infection, discitis, spondylitis, spondylodiscitis, epidural abscess, psoas muscle abscess.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• čas zasáhnout při rozvinutí nemoci MeSH
• centra terciární péče MeSH
• discitida diagnostické zobrazování   farmakoterapie   mikrobiologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• meziobratlový kloub diagnostické zobrazování   mikrobiologie   MeSH
• ortopedické výkony MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spondylitida diagnostické zobrazování   farmakoterapie   mikrobiologie   MeSH
• stafylokokové infekce diagnostické zobrazování   farmakoterapie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• klinické lékařství MeSH
• rehabilitace MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• rehabilitační a fyzikální medicína
• NLK Publikační typ
• kolektivní monografie

Cíl. Zhodnotit možnosti hybridního zobrazení a frekvenci používaných výkonů v detekci okultního muskuloskeletálního pyogenního zánětu jako příčiny sepse. Metoda. Retrospektivně byly zhodnocena hybridní zobrazení indikovaná během 3 let k detekci příčiny septického stavu nejasného původu, vyšetření byla vyhledána mezi všemi provedenými 18F-FDG-PET/CT a SPECT/CT. Výsledky. Bylo provedeno celkem 27 vyšetření 18F-FDG-PET/CT z indikace sepse nejasného původu, kdy v šesti případech byla nalezena spondylodiscitida, pyogenní artritida ve třech případech, svalový absces ve dvou případech a infekce endoprotézy ve čtyřech případech. Muskuloskeletální příčina sepse tvořila 55,5 % případů. Bylo provedeno celkem 16 vyšetření SPECT/CT, kdy v deseti případech byly použity techneciem značené fragmenty myších protilátek a v šesti případech leukocyty značené 99mTc-HMPAO. Ve dvou případech byla prokázána akutní spondylodiscitida, v jednom případě chronická spondylitida a v jednom případě mnohočetné abscesy svalů původem v infekci endoprotézy. Muskuloskeletální příčina tvořila 25 % nálezů. Závěr. Za dobu současného používání PET/CT a SPECT/CT v detekci okultních infekcí tvoří větší díl vyšetření pomocí 18F-FDG-PET/CT, neboť nabízí vícečetné výhody před zobrazeními leukocytárními.

Aim. To asses a role and frequency of indications of hybrid imaging methods in the detection of occult pyogenous musculoskeletal inflammation as a cause of the septic state of unknown origin. Method. The retrospective evaluation of the hybrid imaging indicated due a sepsis of unknown origin during three years was performed. All procedures of 18F-FDG-PET/CT and the SPECT/CT using labeled leucocytes were enrolled into the assessment. Results. 27 procedures of 18F-FDG-PET/ CT were performed due to the searching of the cause in cases of the sepsis of unknown origin; the spondylodiscitis was found in 6 cases, pyogenous arthritis in 3 cases, muscular abscesses in 2 cases and 4 cases of pyogenous infection of implanted joint prosthesis. Muskuloskeletal inflammations formed 55,5% of all findings. 16 procedures of SPECT/CT were performed, 10 using 99mTc-labeled antigranulocyte antibodies, and 6 using 99mTc-HMPAO labeled leukocytes. In 2 cases, the acute spondylodiscitis was found, one case of chronic spon-dylitis and one case of soft tissue abscesses due to the infection of endoprosthesis were found. Muskuloskeletal inflammations formed 25% of all findings. Conclusion. During the period of the parallel use of PET/CT and SPECT/CT in detection of occult infection, the majority of procedures were performed using 18F-FDG-PET/CT, offering multiple advantages over leukocyte imaging.

• Klíčová slova
• SPECT/ CT, značené leukocyty, antileukocytární protilátka,
• MeSH
• dospělí MeSH
• leukocyty MeSH
• lidé středního věku MeSH
• lidé MeSH
• multimodální zobrazování * využití   MeSH
• muskuloskeletální nemoci diagnóza   MeSH
• myší monoklonální protilátky diagnostické užití   MeSH
• PET/CT MeSH
• senioři MeSH
• sepse * diagnóza   etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• hodnotící studie MeSH
• práce podpořená grantem MeSH

Surgical treatment of spondylodiscitis is associated with many complications and raises a number of issues for discussion. The aim of the study was to evaluate a group of patients who had undergone surgery for inflammation of the spine, and to discuss the optimal operative procedure. MATERIAL: Between January 2000 and February 2005, a total of 81 patients were treated at our department for pyogenic or tuberculous spondylodiscitis. Of these, 31 (11 women and 20 men) underwent surgery. Patients treated by CT-guided abscess drainage puncture with antibiotic therapy were not included. Indications for surgery included neurological deficit in 20 patients, deformity or mechanic instability in six, and progressing septic condition in three patients. METHODS: Simple decompression of nerve structures from the posterior approach, combined with drainage, was performed in seven patients, revision surgery from the posterior approach and fusion completed with suction drainage was done in five, anterior radical debridement and stabilization of the anterior column by replacement of the vertebral body was performed in 15 patients, and an anterior procedure completed with posterior instrumentation and fusion was carried out in four patients. The patients were followed up and evaluated at 3, 6 and 12 months post-operatively. RESULTS: Improvement in neurological deficit by one or more Frankel grades was recorded in 30 % of the patients treated by posterior decompression and suction drainage, and in 83 % of the patients undergoing anterior debridement and stabilization. Further progression of deep infection requiring revision surgery and implant removal occurred in one patient. Clinical outcomes assessed as good or satisfactory were found in 68 % and poor results were in 32 % of the patients. DISCUSSION: The selection of an optimal surgical procedure in spondylodiscitis depends on the primary localization of infectious lesions. In a typical anterior form of spondylodiscitis, anterior debridement and suction drainage are preferred. Reconstruction of the anterior spinal column in the presence of major destruction, and stabilization of an infected spine still remain challenging issues. CONCLUSIONS: Radical debridement with deformity correction and segmental stabilization provide an efficient method of treatment for the most frequent anterior forms of pyogenic and tuberculous spondylodiscitis. The use of titan implants does not significantly increase the risk of persistent infection or its recurrence.

• MeSH
• discitida diagnóza   chirurgie   komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

Pyogenní spondylodiscitida je formou osteomyelitidy, při které je zánětem postižen disk a oba sousední obratie. Kazuistika ukazuje na typický průběh onemocnění v obraze klinickém, biochemickém a v zobrazovacích metodách. Magnetická rezonance pomáhá jako neinvazivní metoda stanovit diagnózu. Optimální léčba je založena na kultivaci a ajištěné citlivosti na antibiotika, obvykle z hemokultury. MR umožňuje monitorovat hojení kostních změn i po odeznění klinických příznaků a ukázat reziduálni nález.

Pyogenic spondylodiscitis involves the disc space and the two adjacent vertebral bodies. Our case study shows the clinical, laboratory and imaging follow up in a patient with prompt relief after cure with antibiotics that were given according to the cultivation and sensitivity of the pathogen from the blood culture. MRI enables monitoring of osseous changes even after regression of clinical symptoms and to demonstrate the residual finding.

• MeSH
• discitida farmakoterapie   mikrobiologie   MeSH
• finanční podpora výzkumu jako téma MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• osteomyelitida diagnóza   farmakoterapie   patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH