Diffuse idiopathic skeletal hyperostosis was the specific risk factors of methicillin-susceptible Staphylococcus aureus spine infection: a retrospective study in a single center

PeerJ. 2024 Nov 26:12:e18432. doi: 10.7717/peerj.18432. eCollection 2024.

Abstract

Aim: To investigate how risk factors and reduced spinal mobility contribute to spinal infections arising from methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, known for increased mortality and diagnostic difficulties, especially in patients with septic shock or coma.

Methods: This retrospective study divided MSSA bacteremia patients into three groups: spinal infections (Group A, n = 14), non-spinal/implant infections (Group B, n = 24), and implant-related infections (Group C, n = 21). Analyses focused on demographics, medical history, laboratory inflammatory markers at antibiotic initiation, and spinal pathologies detected by CT. All results of the statistical analyses were significant at P < 0.05. We employed multinomial univariable logistic regression and contingency table analysis to assess risk factors across three groups. Subsequently, binomial multivariable logistic regression was used to compare Group A against Groups B and C, successfully identifying significant predictors of spinal infection.

Results: A lower incidence of diabetes (p = 0.029), higher C-reactive protein (CRP) levels at onset (p = 0.014), and the presence of diffuse idiopathic skeletal hyperostosis (diffuse idiopathic skeletal hyperostosis (DISH); p = 0.022) were significantly associated with spinal infections in Group A. Furthermore, binomial analysis revealed DISH (Odds Ratio (OR) = 41.750; 95% Confidence Interval (CI) [1.86-939.0]; p = 0.019), absence of diabetes (OR = 1.20, CI [1.01-1.43], p = 0.038), elevated CRP (OR = 23.34, CI [1.13-483.4], p = 0.042), and a lower day 3/day 1 white blood cell (WBC) ratio (OR = 0.964, CI [0.93-1.00], p = 0.047) as risk factors when compared with other groups.

Conclusion: Spinal infection patients with MSSA bacteremia are less likely to have diabetes and more likely to have higher initial CRP levels and DISH. Notably, DISH might be emerging as a distinctive risk factor for spinal infection, underscoring its potential as a marker for clinical awareness.

Keywords: Diffuse idiopathic skeletal hyperostosis; Infection; Methicillin-susceptible Staphylococcus aureus; Spine.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / epidemiology
  • Bacteremia / microbiology
  • C-Reactive Protein* / analysis
  • C-Reactive Protein* / metabolism
  • Female
  • Humans
  • Hyperostosis, Diffuse Idiopathic Skeletal* / epidemiology
  • Male
  • Methicillin / pharmacology
  • Methicillin / therapeutic use
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Staphylococcal Infections* / epidemiology
  • Staphylococcal Infections* / microbiology
  • Staphylococcus aureus*

Substances

  • C-Reactive Protein
  • Anti-Bacterial Agents
  • Methicillin

Grants and funding

The authors received no funding for this work.