SAT0497 Epidemiological Study of Infectious Spondylitis in A Tunisian Center: about 118 Cases

BackgroundInfectious spondylitis remains frequent in Tunisia and is a common reason for hospitalization in rheumatology. We report the experience of our rheumatology department in the diagnosis and management of infectious spondylitis.MethodsThis is a retrospective study of 118 cases of infectious spondylitis observed between 1997 and 2015. The diagnosis was based on clinical, biological, radiological and bacteriological data.ResultsOur population consisted of 76 men (64.4%) and 42 women (35.6%) with a mean age of 59.2 years [18–84]. A supporting ground was found in 27% of patients. This was diabetes in 17.8% of cases, extra-articular history of tuberculosis in 7.6% of cases, hemodialysis for renal failure in 2.5% of cases, recent spinal surgery in 3.4% of cases, visceral surgery in 2.5% of cases and a long-term corticosteroid in 1.2% of cases. Spinal pain was present in all cases and had an inflammatory rhythm in 89.8% of cases. Fever was observed in 48.3% of cases, night sweats in 27.1% of cases and impaired general condition in 50% of cases. Neurological signs, present in 55.9% of cases were: radiculalgia in 55.1% of cases, motor deficit in 20.3% of cases and spinal cord compression in 9.3% of cases. The inflammatory syndrome was absent in 10.2% of cases. Spinal MRI and CT performed respectively in 77% and 47.4% of cases showed an epidural in 52.5%, a soft tissue abscess in 34.7%, soft tissue infiltration in 27.9% and a root canal abscess in 14.4% of cases. The spondylitis was multifocal in 7.7% and multi-stage in 11% of cases. Affected levels were: lumbar spine in 66.6%, the thoracic level in 26.9% and the cervical level in 8.5% of cases. The germ was isolated in 53.5% of cases. The disco-vertebral biopsy (performed in 42.3% of cases) was contributory in 27.2% of cases. A puncture of a soft tissue abscess (formed in 14.1% of cases) was contributory in 85.9% of cases. Blood cultures were positive in 7.7% of cases. The urine culture had found the germ in 6.4% of cases and a skin sample in 1.2% of cases. Wright serology was positive in 20.5% of cases. These germs were: tuberculosis in 44.9% of cases, brucellosis in 20.5% and pyogenic germs in 29.5% of cases.ConclusionsThe clinical presentation of infectious spondylitis is polymorphic and determination of the causative organism can be difficult. In our series, in most cases it was a spondylodiscitis -specific germ. Support by appropriate antibiotic therapy leads overall to a good clinical outcome. Neurolog