BACKGROUND CONTEXT: Time to culture positivity (TTP) is a recognized surrogate for bacterial load and virulence in bloodstream infections; however, its prognostic utility using intraoperative tissue cultures in pyogenic spondylodiscitis remains undefined. Furthermore, the optimal surgical window in this context remains to be established.
PURPOSE: This study aims to determine the prognostic value of TTP and identify the optimal surgical timing in patients with de novo Staphylococcus-related pyogenic spondylodiscitis.
PATIENT SAMPLE: Forty-eight consecutive patients treated surgically for de novo Staphylococcus-related pyogenic spondylodiscitis between 2015 and 2021 (mean age: 61.8 years).
OUTCOME MEASURES: The primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Recurrence was defined as the need for revision surgery due to recurrent spondylodiscitis following the completion of antibiotic therapy.
METHODS: Univariate and multivariate Cox regression analyses were performed to identify predictors of primary outcomes. Optimal cut-off values for TTP and surgical timing were analyzed to maximize prognostic discrimination.
RESULTS: The 1-year OS and RFS were 76% and 58%, respectively. A prolonged TTP (≥ 60 hours) and timely surgery (≤ 14 days) were associated with improved outcomes, demonstrating significantly better OS (HR 0.18, p = 0.003; HR 0.22, p = 0.019) and RFS (HR 0.27, p = 0.003; HR 0.35, p = 0.024).
CONCLUSIONS: In this cohort, timely surgery (within 14 days) and prolonged TTP (more than 60 hours) were associated with improved overall and recurrence-free survival. These findings suggest that integrating specific surgical timeframes and bacterial growth characteristics may enhance risk stratification and guide management in Staphylococcus-related pyogenic spondylodiscitis.
STUDY DESIGN/ SETTING: Retrospective cohort study in a tertiary referral medical center.
Read the article: PubMed · Publisher (DOI)