High prevalence of pyogenic spondylodiscitis cases in a third level university infectious diseases center: A case series and literature review

Spondylodiscitis, an infection involving the verte‑ brae and interposed discs, can arise from hematogenous spread or from direct virulent inoculation during spinal surgery. Symptoms are non‑specific, with a subacute clinical course. Currently, the severe acute respiratory syndrome‑coronavirus 2 (SARS‑CoV‑2) pandemic has led to a further delay in diag‑ nosis, with devastating consequences and complications. The present study presents a case series with the aim of describing the etiology, clinical characteristics and complications of the cases of spondylodiscitis observed. The present study is a single‑center retrospective case series of cases observed during the period from January 1 to June 30, 2022. Data were collected anonymously in an electronic spreadsheet. All patients signed a general informed consent to allow the anony‑ mous use of their data upon admission. A total of 6 patients were admitted to hospital during the period of interest; 5 cases were primary cases (83.3%). During the same period in 2019, before the SARS‑CoV‑2 pandemics, only 2 cases of spondylodiscitis were diagnosed and treated, both primary infections. In 3 cases (50.0%) the infection only involved the lumbar vertebrae, in 2 cases (33.3%) it involved the dorsal and lumbar vertebrae, in 1 case it involved the localization was in the dorsal vertebrae (16.7%) and in another case, only the cervical vertebrae were involved (16.7%). Etiology was identified in a Gram‑positive germ [Staphylococcus sciuri, Streptococcus agalactiae, Enterococcus faecalis; methicillin‑resistant Staphylococcus aureus (MRSA)] in 4 cases (66.6%), and in both a Gram‑positive (MRSA) and a Gram‑negative germ (Pseudomonas aeruginosa) in 1 case (16.6%). Of note, 1 case remained undetermined (16.6%). In 2 cases, an endocarditis secondary to primary spondylodiscitis was also found. On the whole, spondylodiscitis is a rare infec‑ tious disease with a subacute course, the origin of which often remains unrecognized. During the SARS‑CoV‑2 pandemic, the diagnostic delay led to an increase of >300% in the diag‑ noses at the authors' center and a worsening of the prognosis.