Pyogenic Spondyliodiscitis with Negative Culture Result: A Comparative Study of Clinical Course Versus Positive Culture Result

Lee, Jung Hwan; Song, Geun Sung; Son, Dong Wuk; Choi, Byung Kwan

Abstract

OBJECTIVE
This study is performed to compare the clinical courses (feature, treatment and outcomes) in patients with negative versus positive culture result in pyogenic spondylodiscitis.
METHODS
From January 2001 to December 2006, we reviewed clinical data in 26 consecutive patients with pyogenic spondylodiscitis retrospectively. We exclude patients that underwent surgical irrigation or debridement with biopsy. We measured clinical outcomes, length of antibiotic administration, recurrence rate, laboratory studies (CRP, ESR and leukocyte counts) and complications between two groups. Clinical outcomes were rated with Macnab's criteria.
RESULTS
Causative organisms were confirmed in 6 cases and the other 20 cases had negative culture result. Mean follow-up duration was 13 months. Mean intravenous antibiotics administration duration of patients having negative culture result was 8.4 weeks and oral was 5 months. On the other hand, in cases of positive culture result, mean intravenous duration was 8.7 weeks and oral was 5.2 months. Initial mean ESR and CRP were elevated, and decreased in both groups according to antibiotics medication (p<0.001 and p=0.001). But initial mean WBC count was normal range. There was no difference in tendencies of decrement of ESR and CRP between two groups (p=0.61 and p=0.571). Clinical outcomes (p=0.231) and complications (p=0.558) were not significantly different. There were no recurrence case for followup period.
CONCLUSION
Negative culture results did not significantly affect the clinical course of pyogenic spondylodiscitis when we compared the clinical courses of both groups.