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Valvular heart disease
Original research
Spondylodiscitis complicating infective endocarditis
  1. Andreina Carbone1,
  2. Audrey Lieu2,3,
  3. Basile Mouhat1,
  4. Francesco Santelli4,
  5. Mary Philip1,
  6. Yohann Bohbot2,3,
  7. Laetitia Tessonnier5,
  8. Fanny Peugnet2,3,
  9. Antonello D'Andrea6,7,
  10. Serge Cammilleri5,
  11. Quentin Delpierre2,3,
  12. Frédérique Gouriet8,9,
  13. Laurence Camoin-Jau9,10,
  14. Mesut Gun2,3,
  15. Jean-Paul Casalta8,9,
  16. Alberto Riberi11,
  17. Frederic Collart1,
  18. Hélène Martel1,
  19. Florent Arregle1,
  20. Eric Guedj5,
  21. Didier Raoult8,9,
  22. Michel Drancourt8,9,
  23. Christophe Tribouilloy2,3,
  24. Gilbert Habib1,9
  1. 1 Cardiology Department, APHM, La Timone Hospital, Marseille, France
  2. 2 Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France
  3. 3 Research Unity 2 EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France
  4. 4 Department of Social Sciences, University Federico II, Naples, Italy
  5. 5 Department of Nuclear Medicine, La Timone Hospital, Marseille, France
  6. 6 Luigi Vanvitelli University—Naples, Monaldi Hospital, Naples, Italy
  7. 7 Dipartimento di Scienze Cardio-Toraciche e Respiratorie, Università degli Studi della Campania "Luigi Vanvitelli, Naples, Italy
  8. 8 URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095—IHU, Marseille, France
  9. 9 Aix Marseille University, IRD, APHM, MEPHI, IHU—Méditerranée Infection, Marseille, France
  10. 10 Department of Hematology, La Timone Hospital, Marseille, France
  11. 11 Department of Cardiac surgery, La timone Hospital, Marseille, France
  1. Correspondence to Professor Gilbert Habib, Cardiology Department, Hospital La Timone, Insuffisance cardiaque et valvulopathie, Marseille 13005, France; gilbert.habib3{at}gmail.com

Abstract

Objective The primary objective was to assess the characteristics and prognosis of pyogenic spondylodiscitis (PS) in patients with infective endocarditis (IE). The secondary objectives were to assess the factors associated with occurrence of PS.

Methods Prospective case–control bi-centre study of 1755 patients with definite IE with (n=150) or without (n=1605) PS. Clinical, microbiological and prognostic variables were recorded.

Results Patients with PS were older (mean age 69.7±18 vs 66.2±14; p=0.004) and had more arterial hypertension (48% vs 34.5%; p<0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without PS. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L4–L5. Neurological symptoms were observed in 59% of patients. Enterococci and Streptococcus gallolyticus were more frequent (24% vs 12% and 24% vs 11%; p<0001, respectively) in the PS group. The diagnosis of PS was based on contrast-enhanced MRI in 92 patients, bone CT in 88 patients and 18F-FDG PET/CT in 56 patients. In-hospital (16% vs 13.5%, p=0.38) and 1-year (21% vs 22%, p=0.82) mortalities did not differ between patients with or without PS.

Conclusions PS is a frequent complication of IE (8.5% of IE), is observed in older hypertensive patients with enterococcal or S. gallolyticus IE, and has a similar prognosis than other forms of IE. Since PS is associated with specific management, multimodality imaging including MRI, CT and PET/CT should be used for early diagnosis of this complication of endocarditis.

  • endocarditis
  • cardiac imaging and diagnostics

https://doi.org/10.1136/heartjnl-2019-316492

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    Footnotes

    • Twitter @Lieu, @Gilbert HABIB

    • Contributors All authors have participated in the work and have reviewed and agreed with the content of the article. AC, BM and GH were mainly responsible for the conduct and writing of the study. All other authors contributed to the planning and reviewing of the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.