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2017 ; 7
(ä): 60
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Pathogen Identification in Suspected Cases of Pyogenic Spondylodiscitis
#MMPMID28337426
Sheikh AF
; Khosravi AD
; Goodarzi H
; Nashibi R
; Teimouri A
; Motamedfar A
; Ranjbar R
; Afzalzadeh S
; Cyrus M
; Hashemzadeh M
Front Cell Infect Microbiol
2017[]; 7
(ä): 60
PMID28337426
show ga
Pyogenic spinal infection continues to represent a worldwide problem. In
approximately one-third of patients with pyogenic spondylodiscitis, the
infectious agent is never identified. Of the cases that lead to organismal
identification, bacteria are more commonly isolated from the spine rather than
fungi and parasites. This study applied universal prokaryotic 16S rRNA PCR as a
rapid diagnostic tool for the detection of bacterial agents in specimens from
patients suspected of pyogenic spondylodiscitis. Gram and Ziehl-Neelsen staining
were used as a preliminary screening measure for microbiologic evaluation of
patient samples. PCR amplification targeting 16S rRNA gene was performed on DNA
extracted from 57 cases including specimens from epidural abscesses, vertebral,
and disc biopsies. Positive samples were directly sequenced. MRI findings
demonstrated that disc destruction and inflammation were the major imaging
features of suspected pyogenic spondylodiscitis cases, as 44 cases showed such
features. The most common site of infection was the lumbar spine (66.7%),
followed by thoracic spine (19%), the sacroiliac joint (9.5%), and
lumbar-thoracic spine (4.8%) regions. A total of 21 samples amplified the 16S
rRNA-PCR product. Sanger sequencing of the PCR products identified the following
bacteriological agents: Mycobacterium tuberculosis (n = 9; 42.9%), Staphylococcus
aureus (n = 6; 28.5%), Mycobacterium abscessus (n = 5; 23.8%), and Mycobacterium
chelonae (n = 1; 4.8%). 36 samples displayed no visible 16S rRNA PCR signal,
which suggested that non-bacterial infectious agents (e.g., fungi) or
non-infectious processes (e.g., inflammatory, or neoplastic) may be responsible
for some of these cases. The L3-L4 site (23.8%) was the most frequent site of
infection. Single disc/vertebral infection were observed in 9 patients (42.85%),
while 12 patients (57.15%) had 2 infected adjacent vertebrae. Elevated
erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) inflammatory
markers were noted in majority of the patients. In conclusion, microbiological
methods and MRI findings are vital components for the proper diagnosis of
pyogenic spondylodiscitis. Our findings suggest that molecular methods such as
clinical application of 16S rRNA PCR and sequencing may be useful as adjunctive
diagnostic tools for pyogenic spondylodiscitis. The rapid turnaround time of 16S
rRNA PCR and sequencing submission and results can potentially decrease the time
to diagnosis and improve the therapeutic management and outcome of these
infections. Although S. aureus and M. tuberculosis were the most common causes of
pyogenic spinal infections in this study, other infectious agents and
non-infectious etiologies should be considered. Based on study results, we advise
that antibiotic therapy should be initiated after a definitive etiological
diagnosis.
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