Document Detail


Treatment of spondylodiscitis in human immunodeficiency virus-infected patients: a comparison of conservative and operative therapy.
MedLine Citation:
PMID:  19478647     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: Multicenter retrospective case series. OBJECTIVE: To determine relevant clinical presentation and outcome of human immunodeficiency virus (HIV)-positive patients with spondylodiscitis as a function of the treatment. SUMMARY OF BACKGROUND DATA: This is the first study comparing the clinical outcome of HIV-positive patients with spondylodiscitis as a function of the treatment. METHODS: We performed a national multicenter retrospective case series comparing operatively versus conservatively treated HIV-positive patients with spondylodiscitis presenting between 1991 and 2007. RESULTS: Twenty patients were included in the study. The average age of the patients at the time of admission was 43.0 years. The sex ratio m:w resulted in 2.3:1. On admission, 50% of the patients were in CDC stage C3. The CD4 T-cell count was determined as being 237.5/microL on average. At the occurrence of spondylodiscitis HIV had been known for a mean 8.5 years. In altogether 75% of the cases a pathogen was found. In 3 cases, mixed infections were present. Half of the patients received surgery. In none of these patients a wound infection or a delay of wound healing could be observed. One patient died during in-patient stay. Eleven of the 19 patients could be followed up a mean 13 months after discharge. In the follow-up period further 3 patients died on an average of 45 months after discharge. CONCLUSION: The occurrence of spondylodiscitis in HIV-positive patients is associated with a low CD4 T-cell count. The probability of mixed infections rises with a CD4 T-cell count <100/microL. The occurrence of spondylodiscitis in HIV-positive patients is accompanied by high mortality. Operative therapy of spondylodiscitis in HIV-positive patients is not associated with an increased surgical complication rate. HIV infection or AIDS should not have an influence on decision-making regarding conservative or operative therapy of spondylodiscitis.
Authors:
R Sobottke; K Zarghooni; M Krengel; S Delank; H Seifert; G Fätkenheuer; I Ernestus; T Källicke; T Frangen; K Arasteh; M Oette; P Eysel
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Spine     Volume:  34     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-29     Completed Date:  2009-09-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E452-8     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery, University of Cologne, Cologne, Germany. rolf.sobottke@uk-koeln.de
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections / complications*,  immunology
Adult
CD4 Lymphocyte Count
Discitis / complications,  immunology,  therapy*
Female
Follow-Up Studies
HIV Infections / complications*,  immunology
Hospitalization / statistics & numerical data
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Compliance / statistics & numerical data
Patient Discharge / statistics & numerical data
Postoperative Complications
Retrospective Studies
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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