[F]FDG PET/CT Imaging Is Associated with Lower In-Hospital Mortality in Patients with Pyogenic Spondylodiscitis-A Registry-Based Analysis of 29,362 Cases

Overview

Journal Antibiotics (Basel)

Specialty Pharmacology

Date 2024 Sep 28

PMID 39335033

Authors

Siegmund Lang

Nike Walter

Stefanie Heidemanns

Constantin Lapa

Melanie Schindler

Jonas Krueckel

Nils Ole Schmidt

Dirk Hellwig

Volker Alt

Markus Rupp

Affiliations

Soon will be listed here.

Abstract

Background: While MRI is the primary diagnostic tool for the diagnosis of spondylodiscitis, the role of [F]-fluorodeoxyglucose ([F]FDG) PET/CT is gaining prominence. This study aimed to determine the frequency of [F]FDG PET/CT usage and its impact on the in-hospital mortality rate in patients with spondylodiscitis, particularly in the geriatric population.

Methods: We conducted a Germany-wide cross-sectional study from 2019 to 2021 using an open-access, Germany-wide database, analyzing cases with ICD-10 codes M46.2-, M46.3-, and M46.4- ('Osteomyelitis of vertebrae', 'Infection of intervertebral disc (pyogenic)', and 'Discitis unspecified'). Diagnostic modalities were compared for their association with in-hospital mortality, with a focus on [F]FDG PET/CT.

Results: In total, 29,362 hospital admissions from 2019 to 2021 were analyzed. Of these, 60.1% were male and 39.9% were female, and 71.8% of the patients were aged 65 years and above. The overall in-hospital mortality rate was 6.5% for the entire cohort and 8.2% for the geriatric subgroup ( < 0.001). Contrast-enhanced (ce) MRI (48.1%) and native CT (39.4%) of the spine were the most frequently conducted diagnostic modalities. [F]FDG PET/CT was performed in 2.7% of cases. CeCT was associated with increased in-hospital mortality (OR = 2.03, 95% CI: 1.90-2.17, < 0.001). Cases with documented [F]FDG PET/CT showed a lower frequency of in-hospital deaths (OR = 0.58, 95% CI: 0.18-0.50; = 0.002). This finding was more pronounced in patients aged 65 and above (OR = 0.42, 95% CI: 0.27-0.65, = 0.001).

Conclusions: Despite its infrequent use, [F]FDG PET/CT was associated with a lower in-hospital mortality rate in patients with spondylodiscitis, particularly in the geriatric cohort. This study is limited by only considering data on hospitalized patients and relying on the assumption of error-free coding. Further research is needed to optimize diagnostic approaches for spondylodiscitis.

References

Abdel-Kader K, Palevsky P . Acute kidney injury in the elderly. Clin Geriatr Med. 2009; 25(3):331-58. PMC: 2748997. DOI: 10.1016/j.cger.2009.04.001. View

Yang J, Xiong D, Jiang J, Xiao L, Li Z . Early Diagnostic Value of 18F-FDG PET/CT in Spontaneous Spondylodiscitis. Pain Med. 2016; 17(4):793-5. DOI: 10.1093/pm/pnv008. View

Kehrer M, Pedersen C, Jensen T, Hallas J, Lassen A . Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population. Spine J. 2015; 15(6):1233-40. DOI: 10.1016/j.spinee.2015.02.021. View

Sans N, Faruch M, Lapegue F, Ponsot A, Chiavassa H, Railhac J . Infections of the spinal column--spondylodiscitis. Diagn Interv Imaging. 2012; 93(6):520-9. DOI: 10.1016/j.diii.2012.04.003. View

van Gerven C, Eid K, Kruger T, Fell M, Kendoff D, Friedrich M . Serum C-reactive protein and WBC count in conservatively and operatively managed bacterial spondylodiscitis. J Orthop Surg (Hong Kong). 2020; 29(1):2309499020968296. DOI: 10.1177/2309499020968296. View

Akiyama T, Chikuda H, Yasunaga H, Horiguchi H, Fushimi K, Saita K . Incidence and risk factors for mortality of vertebral osteomyelitis: a retrospective analysis using the Japanese diagnosis procedure combination database. BMJ Open. 2013; 3(3). PMC: 3612742. DOI: 10.1136/bmjopen-2012-002412. View

Ginde A, Foianini A, Renner D, Valley M, Camargo Jr C . Availability and quality of computed tomography and magnetic resonance imaging equipment in U.S. emergency departments. Acad Emerg Med. 2008; 15(8):780-3. DOI: 10.1111/j.1553-2712.2008.00192.x. View

McCormick P, Lin H, Deiner S, Levin M . Validation of the All Patient Refined Diagnosis Related Group (APR-DRG) Risk of Mortality and Severity of Illness Modifiers as a Measure of Perioperative Risk. J Med Syst. 2018; 42(5):81. PMC: 6750741. DOI: 10.1007/s10916-018-0936-3. View

Jean M, Irisson J, Gras G, Bouchand F, Simo D, Duran C . Diagnostic delay of pyogenic vertebral osteomyelitis and its associated factors. Scand J Rheumatol. 2016; 46(1):64-68. DOI: 10.3109/03009742.2016.1158314. View

10.

Lang S, Fromming A, Walter N, Freigang V, Neumann C, Loibl M . Is There a Difference in Clinical Features, Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Healthcare-Associated and Community-Acquired Vertebral Osteomyelitis?. Antibiotics (Basel). 2021; 10(11). PMC: 8615006. DOI: 10.3390/antibiotics10111410. View

11.

Rupp M, Walter N, Baertl S, Lang S, Lowenberg D, Alt V . Terminology of bone and joint infection. Bone Joint Res. 2021; 10(11):742-743. PMC: 8636293. DOI: 10.1302/2046-3758.1011.BJR-2021-0371. View

12.

Horino T, Sato F, Hosaka Y, Hoshina T, Tamura K, Nakaharai K . Predictive factors for metastatic infection in patients with bacteremia caused by methicillin-sensitive Staphylococcus aureus. Am J Med Sci. 2014; 349(1):24-8. PMC: 4281166. DOI: 10.1097/MAJ.0000000000000350. View

13.

Thottacherry E, Cortes-Penfield N . Evidence of Clinical Impact Supports a New Petition for Medicare Coverage of 2-[18F]Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography/Computed Tomography in the Evaluation of Staphylococcus aureus Bacteremia: A Focused Literature Review and Call.... Clin Infect Dis. 2022; 75(8):1457-1461. DOI: 10.1093/cid/ciac363. View

14.

Abboud T, Melich P, Scheithauer S, Rohde V, Schatlo B . Complications, Length of Hospital Stay, and Cost of Care after Surgery for Pyogenic Spondylodiscitis. J Neurol Surg A Cent Eur Neurosurg. 2022; 84(1):52-57. DOI: 10.1055/a-1811-7633. View

15.

DE Marco M, Lorenzoni L, Addari P, Nante N . [Evaluation of the capacity of the APR-DRG classification system to predict hospital mortality]. Epidemiol Prev. 2002; 26(4):183-90. View

16.

Issa K, Diebo B, Faloon M, Naziri Q, Pourtaheri S, Paulino C . The Epidemiology of Vertebral Osteomyelitis in the United States From 1998 to 2013. Clin Spine Surg. 2017; 31(2):E102-E108. DOI: 10.1097/BSD.0000000000000597. View

17.

Yagdiran A, Otto-Lambertz C, Lingscheid K, Sircar K, Samel C, Scheyerer M . Quality of life and mortality after surgical treatment for vertebral osteomyelitis (VO): a prospective study. Eur Spine J. 2020; 30(6):1721-1731. DOI: 10.1007/s00586-020-06519-z. View

18.

Berbari E, Kanj S, Kowalski T, Darouiche R, Widmer A, Schmitt S . 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis. 2015; 61(6):e26-46. DOI: 10.1093/cid/civ482. View

19.

Segreto F, Beyer G, Grieco P, Horn S, Bortz C, Jalai C . Vertebral Osteomyelitis: A Comparison of Associated Outcomes in Early Versus Delayed Surgical Treatment. Int J Spine Surg. 2019; 12(6):703-712. PMC: 6314341. DOI: 10.14444/5088. View

20.

Dauchy F, Dutertre A, Lawson-Ayayi S, de Clermont-Gallerande H, Fournier C, Zanotti-Fregonara P . Interest of [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of relapse in patients with spinal infection: a prospective study. Clin Microbiol Infect. 2016; 22(5):438-43. DOI: 10.1016/j.cmi.2015.12.028. View