- Email: [email protected]
P72 Inpatient detection of clostridium difficile toxin
Abstracts P69 A young man with purpuric .I. Gomez, M. Molina, M. (Madrid, E)
I European
lessions and splenomegaly Tejeda, C. Criado, S. Ruiz,
Journal
of Internal
A. Casquero
A 46-year-old man is submitted in the hospital because of purpuric lessions and splenomegaly. He was born in Repdblica Dominicana, but he had been living in Spain for five years. No other medical records. One onth before submission he had weight loss, anorexia, red skin lessions and colitic urine. He brought analyses that showed leukothrombopenia. He did not tell fever, arthritis or myalgias, vomiting nor flu-like syndrome. Physical exploration showed no fever, no lymphadenopaties, pupuric lessions in both legs and arms, hepatomegaly and splenomegaly. Complementary explorations: leukopenia with lymphopenia (2860 Leukos, 25% lymphocites) hb 12, 144000 platelets, sedimentation speed 64. ALT 76. AST 63 GGT 76, LDH 604. Policlonal hypergammaglobulinemia (4 gr). ACE normal, Mantoux - ; virus serologie VHA, VHB, VHC, Epstein Barr, CMV and leishmania) all negative. Thorax Rx normal. Abdominal ultrasonography with ligth hepatomegaly and splenomegaly (20 cm). Antinuclear antibodies 1140, cryoglobulines + , C3 and C4 levels normal. Bone marrow biopsy was made, with no findings. Skin biopsy showed vasculitis leucocytoclastic. One month later the patients was asymptomatic, but the analyses showed anaemia (hb 10.9) platelets 119000 leukocites 2780 and 556 lymphocites, and hepatic enzimes were anormal as before. A new bone marrow biopsy was made without findings and a liver biopsy with some ephitelioid granuloma. Then an splenectomy was made, showing ephiteliod granulomas within Langhans cells including structures than looked like Leishmania. Treatment with Glucantime was started and in later reviews he was asimptomatic and the analitic alterations were corrected. Conclusion: This presentation of Leishmania infection is very atipical. In Spain, Leishmaniosis was endemical years ago, but now is not common.
WO Opportunistic infections in renal transplant recipients VJ. Moreno Cuerda, M. Morales Conejo, J.M. Aguado Morales Cerdan, A. Andres Belmonte (Madrid, E)
Garcia,
J.M.
Background: The risk of infection in transplant recipients is determined by the net state of immunosuppression. The most important factor is the nature of the immunosuppressive therapy. Objective: We studied the incidence of opportunistic infections in renal transplant recipients between 1 and 12 months after renal transplantation. Methods: A retrospective analysis of renal allograft recipients who underwent renal transplantation between 1993 and 1998 in ‘12 de Octubre’ Hospital in Madrid (Spain). The exclusion criteria were: death or suspension of immunosuppressive therapy in the first month after renal transplantation. Opportunistic infection was defined as those which pathogen were included between the following: CMV, VZV, EBV, HSV, Listeria, Nocardia, Mycobacterium, Aspergillus, Candida, Criptococcus, Pneumocystis carinnii. Toxoplasma, Leishmania and other infections which are atypical in patients without immunosuppresive therapy. Systemic or visceral affectation or wound infection is required in all cases. The follow-up was during one year. Results: During one year of follow-up, 570 renal transplantations were enrolled. Of these, 53 patients presented 58 opportunistic infections. The types of infection occurred were: viral 74.2% (43 cases), fungal 20.7% (12 cases), atypical mycobacterium 3.4% (2 cases) and parasitic 1.7% (1 case). The opportunistic infectious diseases found were: CMV (38 cases), VZV (3 cases), HSV (2 cases), Pneumocystis carinnii (3 cases), Aspergillus fumigatus (2 cases), Mucor sp (3 cases), Candida albicans (2 cases), Histoplasma capsulatum (1 case) Scytalidium hyalinum (1 case), M. chelonae (1 case), M. fortuitum (1 case), Leishmania donovanii ( 1 case).
Medicine
14 (2003)
Sl-S159
s53
Conclusions: Fifty-three of 570 (9.30%) renal transplant recipients presented an opportunistic infection. The most frequent pathogen was CMV In spite of the use of trimethoprim-sulfamethoxazole during a year, there were 3 cases of Pneumocystis carinnii pneumonia. In our study, it emphasizes the absence of opportunistic infections caused by M. tuberculosis, Listeria or Nocardia.
P71 Tuberculosis in the autopsy: analysis of 1977 autopsies performed between 1974 and 2002 M. Morales, J.M. Guerra, VJ. Moreno, J.F. Varona, E. Conde, F.J. Martinez-Tello (Madrid, E) Introduction: Tuberculosis (TBC) is a relevant infectious disease in Spain. A number of cases of active tuberculosis are not identified until the patient has died. Objectives: To analyse the clinical characteristics and the autopsy findings of the patients died with TBC in our hospital. Materials and methods: We revised all the autopsies performed in adults in the Pathology Department of our Hospital, between 1974 and 2002. In those cases in which active TBC was found, we studied the autopsy reports and clinical record. Results: In that period, 4656 autopsies were performed in our Hospital, of which 1977 were in adults. Among these, we found 92 cases of active TBC. There were 52 men and 40 women. The mean age of these patients was 64 years. Predisposing factors were identified in 90% of the patients: prior history of tuberculosis, pulmonary disease, hepatopaty, alcoholism or immunesuppression. The most common clinical features were dyspnea (40% of the cases) anorexia and weight loss (25%). 46% of the cases had fever. In the physical examination, 66% of the patientes had rales on the lung, 46% hepatomegaly and 50% moderate malnutrition. The mayor laboratory findings were anemia and leukocytosis. 35% had respiratory insufficiency. The chest radiographs did not reveal any pathologhy in 27% of the patients. A premorten correct clinical diagnoses were done in 42 cases. There were 52% cases of pulmonary TBC, 27% were miliary TBC and 21% extrapulmonary TBC. TBC was considered as the principal disease in 64%, it had directly contributed to death in 60% of cases. The most frequent localizations were lung (78%). lymph nodes (42%) and the liver (25%). Langhan’s giant cells were found in all cases and caseous necrosis in 95% of the cases. Acid-fast bacilli could be observed in tissue in 45% of the cases and Lowenstein culture in 60%. Conclusions: 1. The lack of specific symptoms of TBC can result in a delayed diagnosis or even a misdiagnosis 2. The importance of the autopsy has not diminished in spite of the introduction of new techniques.
P72 Inpatient detection J. Polo, C. Criado, E)
of clostridium difficile toxin S. Ruiz, MI. Tejeda, A. Casquero.
I. Gadea
(Madrid,
Background: Clostridium difficile is a bacteria that often causes diarrhoea in patients previously treated with antibiotics. This is a major problem in hospitalized individuals. The dtagnosis is usually based on rapid detection of cytotoxins in the stools. Aim: To know the prevalence of C. difficile-associated diarrhoea in inpatients at our institution and to analyze their clinical features. Methods: Retrospective review of clinical records of all patients in which a sample of stool was sent in search for C. difficile toxin during a three-month period. Results; A total of 69 samples from 59 patients were sent for detection of the toxin. Thirty-two patients were male (54%). In 26 subjects, no evidence of previous antibiotherapy was found in the history. Only 6 samples yielded a positive result (two of them from the same individual), and all these cases were shown to receive antibiotics previously. From the
S54
Abstracts
I European
Journal
of Internal
remaining samples, up to 24 did not undergo testing due to their solid consistency and 39 were negative. Three positive cases were treated with metronidazole and the other two did not received any drug. Conclusions: In our hospital C. difticile is not a frequent cause of diarrhoea, and in many cases it is looked for in the absence of clinical predisposing factors.
I73 Fever of unknown origin in HIV infected patients. Effect of the high activity antirretroviral therapy J. Abelhin-Martinez, J.M. Guerra-Vales, M.J. Femandez-Cotarelo, M.T. Gonzalez-Alegre (Madrid, E) Objective: To describe the epidemiological features and the etiology of the episodes of fever of unknown origin (FUO) in HIV infected patients, and the changes happened with the use of the high activity antirretroviral therapy (HAART). Methods: Retrospective study of all HIV infected patients attended at a University Hospital in Madrid (Spain) who had suffered an episode of fever of unknown origin (according to the 1991 Durcak and Street criteria) since 1994 to 2000. The analyzed variables were age, sex, AIDS-related disease, CD4-t T lymphocyte, etiology of the episode of FUO, diagnostic methods and antirretroviral therapy. Results: The study population includes 3918 patients. Between the years 1994 and 2000, 276 episodes of FUO were diagnosed (216 in men and 60 in women). The most frequent somce of HIV transmission was the use of parenteral drugs (72.1%). 159 patients (57.6%) complied with AIDS criteria when they presented the episode of FUO, and the median CD4+ T lymphocyte count was 47S/ml. The etiology of the episodes of FUO was: tuberculosis (51 cases), disseminated MA1 infection (63 cases), lymphoma (25 cases), leishmaniasis (47 cases) and other diagnosis (54 cases). 2 patients were diagnosed two of these diseases causing the episode of FUO. In 34 patients the diagnosis persisted unclear despite an exhaustive study. The diagnosis was realized by bone marrow biopsy in 39.8% and micobacterium blood culture in 25.7%. 58 patients were receiving HAART when they presented the episode of FUO. The incidence of FUO in the study period was 1.48 episodes/100 HIV infected patients - year. The incidence was lower in the group of patients receiving HAART than in those not receiving HAART (0.84 vs. 1.85 I100 patients - year). Conclusions: FUO is a syndrome with a considerable incidence in HIV infected patients in advanced stages of immunodepression. The incidence of FUO decreases significantly with the use of HAART. The most frequent etiologies in our patients are disseminated micobacteriosis and leishmaniasis. The bone marrow examination has a high reliability.
I74 Mortality due to Methicillin-resistant Staphylococcus Methicillin-sensitive Staphylococcus aureus nosocomial M.A. De Zarraga, J.A. Carton, I.L. Lagunas, M. Sanchez Tuya (Asturias, E)
aureus infection Cembellin,
and M.J.
Introduction: Nosocomial infections (NI) caused by methicillin-resistant Staphylococcus aureus (MRSA) represent an growing problem in hospitals wordlwide. Mortality was significant. Aim: The aim of the study was to examine mortality of MRSA NI in patients admitted in conventional acme hospitalization units (AHU). Methods: Unmatched case control study. The study was carried out in the University Hospital of Asturias, a 1400-bed teaching hospital. We do not include patients admitted in the ICU. The study was restricted to patients admitted in general AHU. All patients satisfying MRSA NI criteria were selected as cases. Controls were chosen at random among AHU-admitted patients with NI due to methicillin-sensitive Staphylococ-
Medicine
14 (2003)
Sl-S159
cus aureus (MSSA). The customary statistic study was completed with a stepwise logistic regression analysis. Results: At the AHU, 144 patients infected by MRSA and 187 controls were studied. Mortality rate was higher in patients infected by MRSA than in patients infected by MSSA (17.4% vs. 6.4%: p
PI5 Brucellic endocarditis S. Borges, A. Costa,
F. Bourbon,
F. Reis
(Torres
Vedras,
I’)
The authors report a case of a 45.year-old man, Caucasian, worker in a cattle food company presented with 3 month history of fever, back pain and myalgias. Positive Hudlesson and Bengal Rose (reaction). Good initial response to therapy (Doxiciclin and Rifampicin). One month later: Vomiting and fever requiting hospitalization. Objectively: Fever and hepatosplenomegaly. Analytically: Normochromic normocytic anemia, high sedimentation rate and monoclonal gammopathy. Normal bone marrow examination. Echocardiogram: mitral valve with vegetation. Positive serology to Brucella. Treatment for one year. Control echocardiogram: normal, without vegetations. The interest of this case is mostly based upon two factors: the rare involvement of the heart valves in brucellosis and the good evolution in our patient despite that involvement.
PI6 Infectious spondylodiscitis E. Alvarez-Rodriguez, R. Torres-Garate, Cigiienza, D. Espin6s (Madrid, I?)
A. Gutierrez,
M.A.
Lozano,
R.
Objectives: To describe the epidemiology, etiology, clinical presentation, diagnosis and treatment of infectious spondylodiscitis. Design: Transversal descriptive study. Materials and methods: All the 27 documented cases for that diagnosis in the last 5 years in the Hospital Clinico San Carlos (Madrid) were reviewed. The statistical analysis was made with SPSS 11.0. Results: 63% males. Average age: 58.6 years (2 19.4). The infectious organism was isolated in the 70.4% of the cases. The medical services isolated the organism in the 87.5% versus the 45.5% in the surgical ones (difference significant p = 0.03). The most frequent etiologic agents were M. tuberculosis (42%) and Staphylococcus spp. (37%). Detected fever in 56%, neurological deficits in 42.3%, rigidity in 15.4% and constitutional syndrome in 11.5%. Average time to get the diagnosis: 57.7 (253.7) days. Leukocyte was elevated in 53.8% of the cases and high erythrocyte sedimentation rate (ESR) in 95.7%. Lumbar region was the most frequent (55.6%). 96.2% of diagnosis was got through magnetic resonance imaging (MRI). All cases received antibiotic treatment, requiring surgery
I European
lessions and splenomegaly Tejeda, C. Criado, S. Ruiz,
Journal
of Internal
A. Casquero
A 46-year-old man is submitted in the hospital because of purpuric lessions and splenomegaly. He was born in Repdblica Dominicana, but he had been living in Spain for five years. No other medical records. One onth before submission he had weight loss, anorexia, red skin lessions and colitic urine. He brought analyses that showed leukothrombopenia. He did not tell fever, arthritis or myalgias, vomiting nor flu-like syndrome. Physical exploration showed no fever, no lymphadenopaties, pupuric lessions in both legs and arms, hepatomegaly and splenomegaly. Complementary explorations: leukopenia with lymphopenia (2860 Leukos, 25% lymphocites) hb 12, 144000 platelets, sedimentation speed 64. ALT 76. AST 63 GGT 76, LDH 604. Policlonal hypergammaglobulinemia (4 gr). ACE normal, Mantoux - ; virus serologie VHA, VHB, VHC, Epstein Barr, CMV and leishmania) all negative. Thorax Rx normal. Abdominal ultrasonography with ligth hepatomegaly and splenomegaly (20 cm). Antinuclear antibodies 1140, cryoglobulines + , C3 and C4 levels normal. Bone marrow biopsy was made, with no findings. Skin biopsy showed vasculitis leucocytoclastic. One month later the patients was asymptomatic, but the analyses showed anaemia (hb 10.9) platelets 119000 leukocites 2780 and 556 lymphocites, and hepatic enzimes were anormal as before. A new bone marrow biopsy was made without findings and a liver biopsy with some ephitelioid granuloma. Then an splenectomy was made, showing ephiteliod granulomas within Langhans cells including structures than looked like Leishmania. Treatment with Glucantime was started and in later reviews he was asimptomatic and the analitic alterations were corrected. Conclusion: This presentation of Leishmania infection is very atipical. In Spain, Leishmaniosis was endemical years ago, but now is not common.
WO Opportunistic infections in renal transplant recipients VJ. Moreno Cuerda, M. Morales Conejo, J.M. Aguado Morales Cerdan, A. Andres Belmonte (Madrid, E)
Garcia,
J.M.
Background: The risk of infection in transplant recipients is determined by the net state of immunosuppression. The most important factor is the nature of the immunosuppressive therapy. Objective: We studied the incidence of opportunistic infections in renal transplant recipients between 1 and 12 months after renal transplantation. Methods: A retrospective analysis of renal allograft recipients who underwent renal transplantation between 1993 and 1998 in ‘12 de Octubre’ Hospital in Madrid (Spain). The exclusion criteria were: death or suspension of immunosuppressive therapy in the first month after renal transplantation. Opportunistic infection was defined as those which pathogen were included between the following: CMV, VZV, EBV, HSV, Listeria, Nocardia, Mycobacterium, Aspergillus, Candida, Criptococcus, Pneumocystis carinnii. Toxoplasma, Leishmania and other infections which are atypical in patients without immunosuppresive therapy. Systemic or visceral affectation or wound infection is required in all cases. The follow-up was during one year. Results: During one year of follow-up, 570 renal transplantations were enrolled. Of these, 53 patients presented 58 opportunistic infections. The types of infection occurred were: viral 74.2% (43 cases), fungal 20.7% (12 cases), atypical mycobacterium 3.4% (2 cases) and parasitic 1.7% (1 case). The opportunistic infectious diseases found were: CMV (38 cases), VZV (3 cases), HSV (2 cases), Pneumocystis carinnii (3 cases), Aspergillus fumigatus (2 cases), Mucor sp (3 cases), Candida albicans (2 cases), Histoplasma capsulatum (1 case) Scytalidium hyalinum (1 case), M. chelonae (1 case), M. fortuitum (1 case), Leishmania donovanii ( 1 case).
Medicine
14 (2003)
Sl-S159
s53
Conclusions: Fifty-three of 570 (9.30%) renal transplant recipients presented an opportunistic infection. The most frequent pathogen was CMV In spite of the use of trimethoprim-sulfamethoxazole during a year, there were 3 cases of Pneumocystis carinnii pneumonia. In our study, it emphasizes the absence of opportunistic infections caused by M. tuberculosis, Listeria or Nocardia.
P71 Tuberculosis in the autopsy: analysis of 1977 autopsies performed between 1974 and 2002 M. Morales, J.M. Guerra, VJ. Moreno, J.F. Varona, E. Conde, F.J. Martinez-Tello (Madrid, E) Introduction: Tuberculosis (TBC) is a relevant infectious disease in Spain. A number of cases of active tuberculosis are not identified until the patient has died. Objectives: To analyse the clinical characteristics and the autopsy findings of the patients died with TBC in our hospital. Materials and methods: We revised all the autopsies performed in adults in the Pathology Department of our Hospital, between 1974 and 2002. In those cases in which active TBC was found, we studied the autopsy reports and clinical record. Results: In that period, 4656 autopsies were performed in our Hospital, of which 1977 were in adults. Among these, we found 92 cases of active TBC. There were 52 men and 40 women. The mean age of these patients was 64 years. Predisposing factors were identified in 90% of the patients: prior history of tuberculosis, pulmonary disease, hepatopaty, alcoholism or immunesuppression. The most common clinical features were dyspnea (40% of the cases) anorexia and weight loss (25%). 46% of the cases had fever. In the physical examination, 66% of the patientes had rales on the lung, 46% hepatomegaly and 50% moderate malnutrition. The mayor laboratory findings were anemia and leukocytosis. 35% had respiratory insufficiency. The chest radiographs did not reveal any pathologhy in 27% of the patients. A premorten correct clinical diagnoses were done in 42 cases. There were 52% cases of pulmonary TBC, 27% were miliary TBC and 21% extrapulmonary TBC. TBC was considered as the principal disease in 64%, it had directly contributed to death in 60% of cases. The most frequent localizations were lung (78%). lymph nodes (42%) and the liver (25%). Langhan’s giant cells were found in all cases and caseous necrosis in 95% of the cases. Acid-fast bacilli could be observed in tissue in 45% of the cases and Lowenstein culture in 60%. Conclusions: 1. The lack of specific symptoms of TBC can result in a delayed diagnosis or even a misdiagnosis 2. The importance of the autopsy has not diminished in spite of the introduction of new techniques.
P72 Inpatient detection J. Polo, C. Criado, E)
of clostridium difficile toxin S. Ruiz, MI. Tejeda, A. Casquero.
I. Gadea
(Madrid,
Background: Clostridium difficile is a bacteria that often causes diarrhoea in patients previously treated with antibiotics. This is a major problem in hospitalized individuals. The dtagnosis is usually based on rapid detection of cytotoxins in the stools. Aim: To know the prevalence of C. difficile-associated diarrhoea in inpatients at our institution and to analyze their clinical features. Methods: Retrospective review of clinical records of all patients in which a sample of stool was sent in search for C. difficile toxin during a three-month period. Results; A total of 69 samples from 59 patients were sent for detection of the toxin. Thirty-two patients were male (54%). In 26 subjects, no evidence of previous antibiotherapy was found in the history. Only 6 samples yielded a positive result (two of them from the same individual), and all these cases were shown to receive antibiotics previously. From the
S54
Abstracts
I European
Journal
of Internal
remaining samples, up to 24 did not undergo testing due to their solid consistency and 39 were negative. Three positive cases were treated with metronidazole and the other two did not received any drug. Conclusions: In our hospital C. difticile is not a frequent cause of diarrhoea, and in many cases it is looked for in the absence of clinical predisposing factors.
I73 Fever of unknown origin in HIV infected patients. Effect of the high activity antirretroviral therapy J. Abelhin-Martinez, J.M. Guerra-Vales, M.J. Femandez-Cotarelo, M.T. Gonzalez-Alegre (Madrid, E) Objective: To describe the epidemiological features and the etiology of the episodes of fever of unknown origin (FUO) in HIV infected patients, and the changes happened with the use of the high activity antirretroviral therapy (HAART). Methods: Retrospective study of all HIV infected patients attended at a University Hospital in Madrid (Spain) who had suffered an episode of fever of unknown origin (according to the 1991 Durcak and Street criteria) since 1994 to 2000. The analyzed variables were age, sex, AIDS-related disease, CD4-t T lymphocyte, etiology of the episode of FUO, diagnostic methods and antirretroviral therapy. Results: The study population includes 3918 patients. Between the years 1994 and 2000, 276 episodes of FUO were diagnosed (216 in men and 60 in women). The most frequent somce of HIV transmission was the use of parenteral drugs (72.1%). 159 patients (57.6%) complied with AIDS criteria when they presented the episode of FUO, and the median CD4+ T lymphocyte count was 47S/ml. The etiology of the episodes of FUO was: tuberculosis (51 cases), disseminated MA1 infection (63 cases), lymphoma (25 cases), leishmaniasis (47 cases) and other diagnosis (54 cases). 2 patients were diagnosed two of these diseases causing the episode of FUO. In 34 patients the diagnosis persisted unclear despite an exhaustive study. The diagnosis was realized by bone marrow biopsy in 39.8% and micobacterium blood culture in 25.7%. 58 patients were receiving HAART when they presented the episode of FUO. The incidence of FUO in the study period was 1.48 episodes/100 HIV infected patients - year. The incidence was lower in the group of patients receiving HAART than in those not receiving HAART (0.84 vs. 1.85 I100 patients - year). Conclusions: FUO is a syndrome with a considerable incidence in HIV infected patients in advanced stages of immunodepression. The incidence of FUO decreases significantly with the use of HAART. The most frequent etiologies in our patients are disseminated micobacteriosis and leishmaniasis. The bone marrow examination has a high reliability.
I74 Mortality due to Methicillin-resistant Staphylococcus Methicillin-sensitive Staphylococcus aureus nosocomial M.A. De Zarraga, J.A. Carton, I.L. Lagunas, M. Sanchez Tuya (Asturias, E)
aureus infection Cembellin,
and M.J.
Introduction: Nosocomial infections (NI) caused by methicillin-resistant Staphylococcus aureus (MRSA) represent an growing problem in hospitals wordlwide. Mortality was significant. Aim: The aim of the study was to examine mortality of MRSA NI in patients admitted in conventional acme hospitalization units (AHU). Methods: Unmatched case control study. The study was carried out in the University Hospital of Asturias, a 1400-bed teaching hospital. We do not include patients admitted in the ICU. The study was restricted to patients admitted in general AHU. All patients satisfying MRSA NI criteria were selected as cases. Controls were chosen at random among AHU-admitted patients with NI due to methicillin-sensitive Staphylococ-
Medicine
14 (2003)
Sl-S159
cus aureus (MSSA). The customary statistic study was completed with a stepwise logistic regression analysis. Results: At the AHU, 144 patients infected by MRSA and 187 controls were studied. Mortality rate was higher in patients infected by MRSA than in patients infected by MSSA (17.4% vs. 6.4%: p
PI5 Brucellic endocarditis S. Borges, A. Costa,
F. Bourbon,
F. Reis
(Torres
Vedras,
I’)
The authors report a case of a 45.year-old man, Caucasian, worker in a cattle food company presented with 3 month history of fever, back pain and myalgias. Positive Hudlesson and Bengal Rose (reaction). Good initial response to therapy (Doxiciclin and Rifampicin). One month later: Vomiting and fever requiting hospitalization. Objectively: Fever and hepatosplenomegaly. Analytically: Normochromic normocytic anemia, high sedimentation rate and monoclonal gammopathy. Normal bone marrow examination. Echocardiogram: mitral valve with vegetation. Positive serology to Brucella. Treatment for one year. Control echocardiogram: normal, without vegetations. The interest of this case is mostly based upon two factors: the rare involvement of the heart valves in brucellosis and the good evolution in our patient despite that involvement.
PI6 Infectious spondylodiscitis E. Alvarez-Rodriguez, R. Torres-Garate, Cigiienza, D. Espin6s (Madrid, I?)
A. Gutierrez,
M.A.
Lozano,
R.
Objectives: To describe the epidemiology, etiology, clinical presentation, diagnosis and treatment of infectious spondylodiscitis. Design: Transversal descriptive study. Materials and methods: All the 27 documented cases for that diagnosis in the last 5 years in the Hospital Clinico San Carlos (Madrid) were reviewed. The statistical analysis was made with SPSS 11.0. Results: 63% males. Average age: 58.6 years (2 19.4). The infectious organism was isolated in the 70.4% of the cases. The medical services isolated the organism in the 87.5% versus the 45.5% in the surgical ones (difference significant p = 0.03). The most frequent etiologic agents were M. tuberculosis (42%) and Staphylococcus spp. (37%). Detected fever in 56%, neurological deficits in 42.3%, rigidity in 15.4% and constitutional syndrome in 11.5%. Average time to get the diagnosis: 57.7 (253.7) days. Leukocyte was elevated in 53.8% of the cases and high erythrocyte sedimentation rate (ESR) in 95.7%. Lumbar region was the most frequent (55.6%). 96.2% of diagnosis was got through magnetic resonance imaging (MRI). All cases received antibiotic treatment, requiring surgery