Short summary

Infection in the spine is associated with high morbidity and risk of chronic pain and permanent impairment. We want to initiate a research database in the Region of Southern Denmark to improve the diagnostics methods, treatment and quality of care and outcome for patients with spinal infections.

Rationale

Infection in in the spine is associated with high morbidity and risk of chronic pain and permanent neurological deficits. Infection in the spine includes infection of vertebrae (osteomyelitis) with involvement of the disc (spondylodiscitis) and abscess formation with or without bone involvement. 

Little is known of the epidemiology of abscess formation without bone involvement of the spine (epidural or spinal abscess) in Danish patients. The incidence of infectious spondylodiscitis (infection in the vertebra and disc) seems to be increasing; probably due to a combination of a real increase caused by a growing number of elderly and patients with iatrogenic immune deficiency, and partly due to better diagnostics and more awareness among doctors. The incidence among adults in Denmark is probably between 300 and 400 cases per year. Serious long term consequences include permanent neurological deficits, chronic pain, and reduced functional level, all reducing the quality of life. Spondylodiscitis is also associated with reduced ability to work. The most common etiological agents among patients with spondylodiscitis in Denmark are Staphylococcus aureus and Streptococci species. In about one fifth of the cases the causative microorganism remains unknown. 

Imaging plays an important role in the initial diagnosis and management of patients with spondylodiscitis. MRI is considered the "gold standard" for diagnostic imaging. Differentiation between spondylodiscitis, erosive osteochondritis or other non-infectious causes of bone disease is difficult, and discrimination between suspected treatment failure and recurrence may be even more complex. Recurrence is often, but not always, accompanied by elevated blood serologic inflammatory markers. However, identifying patients with actual treatment failure and recurring spondylitis among former spondylodiscitis patients is challenging with present clinical tools, since the exact same symptoms may follow a variety of other conditions. Consequences for patients are huge as recurrence is treated with antibiotics for at least 12 weeks, including 4-8 weeks of intravenous therapy. There is a need for more accurate and evidence-based diagnostic technologies and strategies. 

Treatment consists of antibiotics given for a minimum of 6 weeks and often longer and in about 20% of the cases surgical intervention is also needed. After antibiotic therapy has been completed follows a period with intensive rehabilitation. Recommendations concerning antibiotic therapy are mostly based on findings from retrospective studies, observational studies and expert opinion. Besides choice of antibiotics, which may vary according to aetiology and local pattern of resistance, important questions include duration of therapy and choice of either oral or parenteral antimicrobial therapy. New knowledge from treatment of other infectious diseases (including infectious endocarditis)  and knowledge about drug pharmacokinetics does however indicate that oral therapy - using antibiotics with good oral bioavailability and good penetration to bone tissue - possibly might be as efficient as intravenous therapy in patients with normal intestinal function. Long term intravenous treatment for infectious spondylodiscitis is associated with costs for both patients and society without evidence for a better outcome of the disease with intravenous therapy compared to oral therapy. 

Relapse is known to occur in 5-14% but risk factors associated with relapse needs to be evaluated further and no recent estimates of the relapse rate is described in Denmark, to our knowledge. 

Purpose: 

The overall purpose of this project is to initiate a research database in the Region of Southern Denmark including patients with spine infection to improve the diagnostic methods, treatment and quality of care and outcome of these patients. 

Further investigate the epidemiology, clinical manifestations, diagnostic methods, treatment (antibiotics and surgical) and treatment outcome 

Description of the cohort

Adults treated for spinal infections in collaboration with the Department of Infectious Diseases, Odense University Hospital

Data and biological material

Clinical data

Questionnaires

With time we plan to establish a blood biobank