Management of Severe Pyogenic Spinal Infections: The 2SICK Study by the EANS Spine Section

Andreas Kramer; Santhosh G Thavarajasingam; Jonathan Neuhoff; Felipa Lange; Hariharan Subbiah Ponniah; Sara Lener; Claudius Thomé; Felix C Stengel; Gregor Fischer; Isabel C Hostettler; Martin N Stienen; Maxim Jemna; Konstantinos Gousias; Aleksandra Nedeljkovic; Danica Grujicic; Zarko Nedeljkovic; Jasmina Poluga; Ralph T Schär; Wiktor Urbanski; Carla Sousa; Carlos Daniel Oliveira Casimiro; Helena Harmer; Barbara Ladisich; Matthias Matt; Matthias Simon; Delin Pai; Christian Doenitz; Lorenzo Mongardi; Giorgio Lofrese; Melanie Buchta; Lukas Grassner; Pavel Trávníček; Tomáš Hosszú; Maarten Wissels; Sven Bamps; Waeel Hamouda; Flavio Panico; Diego Garbossa; Marcello Barbato; Manlio Barbarisi; Tobias Pantel; Jens Gempt; Tharaka Sai Kasula; Sohum Desai; Julius Mautin Vitowanu; Bekir Rovčanin; Ibrahim Omerhodzic; Andreas K Demetriades; Benjamin Davies; Ehab Shiban; Florian Ringel

Management of Severe Pyogenic Spinal Infections: The 2SICK Study by the EANS Spine Section

Andreas Kramer, Santhosh G Thavarajasingam, Jonathan Neuhoff, Felipa Lange, Hariharan Subbiah Ponniah, Sara Lener, Claudius Thomé, Felix C Stengel, Gregor Fischer, Isabel C Hostettler, Martin N Stienen, Maxim Jemna, Konstantinos Gousias, Aleksandra Nedeljkovic, Danica Grujicic, Zarko Nedeljkovic, Jasmina Poluga, Ralph T Schär, Wiktor Urbanski, Carla SousaCarlos Daniel Oliveira Casimiro, Helena Harmer, Barbara Ladisich, Matthias Matt, Matthias Simon, Delin Pai, Christian Doenitz, Lorenzo Mongardi, Giorgio Lofrese, Melanie Buchta, Lukas Grassner, Pavel Trávníček, Tomáš Hosszú, Maarten Wissels, Sven Bamps, Waeel Hamouda, Flavio Panico, Diego Garbossa, Marcello Barbato, Manlio Barbarisi, Tobias Pantel, Jens Gempt, Tharaka Sai Kasula, Sohum Desai, Julius Mautin Vitowanu, Bekir Rovčanin, Ibrahim Omerhodzic, Andreas K Demetriades, Benjamin Davies, Ehab Shiban, Florian Ringel

Division of Otorhinolaryngology (University Hospital Krems)

Research output: Journal article (peer-reviewed) › Journal article

Abstract

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<0.001). 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<0.001), and shorter ICU stays (4.52 days) compared to conservative therapy (16.48 days) and early surgery (7.92 days) (p<0.001). The optimal window for surgery, minimizing mortality, was identified as ten to fourteen days post-admission (p=0.02). Risk factors for increased mortality included age (p<0.05), multiple organ failure (p<0.05), and vertebral body destruction (p<0.05), whereas delayed surgery (p<0.05) and the presence of an epidural abscess were associated with reduced mortality (p<0.05).

CONCLUSIONS: Delayed surgery, optimally between 10 to 14 days post-admission, was associated with lower mortality in critically ill spondylodiscitis patients. These findings highlight the potential benefits of considering surgical timing to improve patient outcomes.

Original language	English
Journal	Spine Journal
Publication status	E-pub ahead of print - 11 Dec 2024

Cite this

Kramer, A., Thavarajasingam, S. G., Neuhoff, J., Lange, F., Ponniah, H. S., Lener, S., Thomé, C., Stengel, F. C., Fischer, G., Hostettler, I. C., Stienen, M. N., Jemna, M., Gousias, K., Nedeljkovic, A., Grujicic, D., Nedeljkovic, Z., Poluga, J., Schär, R. T., Urbanski, W., ... Ringel, F. (2024). Management of Severe Pyogenic Spinal Infections: The 2SICK Study by the EANS Spine Section. Spine Journal. Advance online publication.

@article{2adb02a6ea8d4627830e309037c4f2ab,

title = "Management of Severe Pyogenic Spinal Infections: The 2SICK Study by the EANS Spine Section",

abstract = "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<0.001). 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<0.001), and shorter ICU stays (4.52 days) compared to conservative therapy (16.48 days) and early surgery (7.92 days) (p<0.001). The optimal window for surgery, minimizing mortality, was identified as ten to fourteen days post-admission (p=0.02). Risk factors for increased mortality included age (p<0.05), multiple organ failure (p<0.05), and vertebral body destruction (p<0.05), whereas delayed surgery (p<0.05) and the presence of an epidural abscess were associated with reduced mortality (p<0.05).CONCLUSIONS: Delayed surgery, optimally between 10 to 14 days post-admission, was associated with lower mortality in critically ill spondylodiscitis patients. These findings highlight the potential benefits of considering surgical timing to improve patient outcomes.",

author = "Andreas Kramer and Thavarajasingam, {Santhosh G} and Jonathan Neuhoff and Felipa Lange and Ponniah, {Hariharan Subbiah} and Sara Lener and Claudius Thom{\'e} and Stengel, {Felix C} and Gregor Fischer and Hostettler, {Isabel C} and Stienen, {Martin N} and Maxim Jemna and Konstantinos Gousias and Aleksandra Nedeljkovic and Danica Grujicic and Zarko Nedeljkovic and Jasmina Poluga and Sch{\"a}r, {Ralph T} and Wiktor Urbanski and Carla Sousa and Casimiro, {Carlos Daniel Oliveira} and Helena Harmer and Barbara Ladisich and Matthias Matt and Matthias Simon and Delin Pai and Christian Doenitz and Lorenzo Mongardi and Giorgio Lofrese and Melanie Buchta and Lukas Grassner and Pavel Tr{\'a}vn{\'i}{\v c}ek and Tom{\'a}{\v s} Hossz{\'u} and Maarten Wissels and Sven Bamps and Waeel Hamouda and Flavio Panico and Diego Garbossa and Marcello Barbato and Manlio Barbarisi and Tobias Pantel and Jens Gempt and Kasula, {Tharaka Sai} and Sohum Desai and Vitowanu, {Julius Mautin} and Bekir Rov{\v c}anin and Ibrahim Omerhodzic and Demetriades, {Andreas K} and Benjamin Davies and Ehab Shiban and Florian Ringel",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s)",

year = "2024",

month = dec,

day = "11",

language = "English",

journal = "Spine Journal",

issn = "1529-9430",

publisher = "Elsevier Inc.",

}

Kramer, A, Thavarajasingam, SG, Neuhoff, J, Lange, F, Ponniah, HS, Lener, S, Thomé, C, Stengel, FC, Fischer, G, Hostettler, IC, Stienen, MN, Jemna, M, Gousias, K, Nedeljkovic, A, Grujicic, D, Nedeljkovic, Z, Poluga, J, Schär, RT, Urbanski, W, Sousa, C, Casimiro, CDO, Harmer, H, Ladisich, B, Matt, M, Simon, M, Pai, D, Doenitz, C, Mongardi, L, Lofrese, G, Buchta, M, Grassner, L, Trávníček, P, Hosszú, T, Wissels, M, Bamps, S, Hamouda, W, Panico, F, Garbossa, D, Barbato, M, Barbarisi, M, Pantel, T, Gempt, J, Kasula, TS, Desai, S, Vitowanu, JM, Rovčanin, B, Omerhodzic, I, Demetriades, AK, Davies, B, Shiban, E & Ringel, F 2024, 'Management of Severe Pyogenic Spinal Infections: The 2SICK Study by the EANS Spine Section', Spine Journal.

TY - JOUR

T1 - Management of Severe Pyogenic Spinal Infections

T2 - The 2SICK Study by the EANS Spine Section

AU - Kramer, Andreas

AU - Thavarajasingam, Santhosh G

AU - Neuhoff, Jonathan

AU - Lange, Felipa

AU - Ponniah, Hariharan Subbiah

AU - Lener, Sara

AU - Thomé, Claudius

AU - Stengel, Felix C

AU - Fischer, Gregor

AU - Hostettler, Isabel C

AU - Stienen, Martin N

AU - Jemna, Maxim

AU - Gousias, Konstantinos

AU - Nedeljkovic, Aleksandra

AU - Grujicic, Danica

AU - Nedeljkovic, Zarko

AU - Poluga, Jasmina

AU - Schär, Ralph T

AU - Urbanski, Wiktor

AU - Sousa, Carla

AU - Casimiro, Carlos Daniel Oliveira

AU - Harmer, Helena

AU - Ladisich, Barbara

AU - Matt, Matthias

AU - Simon, Matthias

AU - Pai, Delin

AU - Doenitz, Christian

AU - Mongardi, Lorenzo

AU - Lofrese, Giorgio

AU - Buchta, Melanie

AU - Grassner, Lukas

AU - Trávníček, Pavel

AU - Hosszú, Tomáš

AU - Wissels, Maarten

AU - Bamps, Sven

AU - Hamouda, Waeel

AU - Panico, Flavio

AU - Garbossa, Diego

AU - Barbato, Marcello

AU - Barbarisi, Manlio

AU - Pantel, Tobias

AU - Gempt, Jens

AU - Kasula, Tharaka Sai

AU - Desai, Sohum

AU - Vitowanu, Julius Mautin

AU - Rovčanin, Bekir

AU - Omerhodzic, Ibrahim

AU - Demetriades, Andreas K

AU - Davies, Benjamin

AU - Shiban, Ehab

AU - Ringel, Florian

PY - 2024/12/11

Y1 - 2024/12/11

N2 - 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<0.001). 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<0.001), and shorter ICU stays (4.52 days) compared to conservative therapy (16.48 days) and early surgery (7.92 days) (p<0.001). The optimal window for surgery, minimizing mortality, was identified as ten to fourteen days post-admission (p=0.02). Risk factors for increased mortality included age (p<0.05), multiple organ failure (p<0.05), and vertebral body destruction (p<0.05), whereas delayed surgery (p<0.05) and the presence of an epidural abscess were associated with reduced mortality (p<0.05).CONCLUSIONS: Delayed surgery, optimally between 10 to 14 days post-admission, was associated with lower mortality in critically ill spondylodiscitis patients. These findings highlight the potential benefits of considering surgical timing to improve patient outcomes.

AB - 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<0.001). 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<0.001), and shorter ICU stays (4.52 days) compared to conservative therapy (16.48 days) and early surgery (7.92 days) (p<0.001). The optimal window for surgery, minimizing mortality, was identified as ten to fourteen days post-admission (p=0.02). Risk factors for increased mortality included age (p<0.05), multiple organ failure (p<0.05), and vertebral body destruction (p<0.05), whereas delayed surgery (p<0.05) and the presence of an epidural abscess were associated with reduced mortality (p<0.05).CONCLUSIONS: Delayed surgery, optimally between 10 to 14 days post-admission, was associated with lower mortality in critically ill spondylodiscitis patients. These findings highlight the potential benefits of considering surgical timing to improve patient outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85214265939&partnerID=8YFLogxK

M3 - Journal article

C2 - 39672206

SN - 1529-9430

JO - Spine Journal

JF - Spine Journal

ER -

Management of Severe Pyogenic Spinal Infections: The 2SICK Study by the EANS Spine Section

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