YOR-SPINE: A retrospective cohort study describing the epidemiology, management and clinical outcomes in spinal infections at Leeds Teaching Hospitals NHS Trust, UK between 2022-25
Background:
Pyogenic spinal infections are increasing in prevalence and are associated with significant morbidity and mortality and often require complex prolonged treatment (1,2,3). This is a retrospective cohort study of 213 patients managed for native and implant-associated spinal infection between January 2022 and December 2025 at Leeds Teaching Hospitals NHS Trust.
Objectives:
-Describe the cohort of spinal infections, including native and implant-associated
-Describe the microbiological aetiology of infections including proportion of culture-confirmed versus culture-negative cases
-Describe antimicrobial therapy, including choice, duration and oral switch
-Describe clinical outcomes of native and implant-associated spinal infection cases, including how antimicrobial treatment choices and surgical management affect patient outcomes
Methods:
Eligible patients were identified from spinal infection MDT lists.
INCLUSION CRITERIA:
-All adult patients (over 18-years) with spinal infection managed at LTHT during study period (January 2022-December 2025)
EXCLUSION CRITERIA:
-Children under 18-years of age
-Infection caused by mycobacterial species, Brucella species and fungi
Data was collected using electronic health records and laboratory systems and recorded on an excel data collection form and stored on an NHS secure drive. Statistical analysis was performed using excel and GraphPad Prism.
Results:
•213 patients were included in the analysis (table 1); 159 native infections, and 54 implant-associated infections (33 defined as early onset <6 weeks, and 21 late onset >6 weeks).
•Native infections were more likely to present systemically unwell compared to implant-associated, with SIRS criteria present in 49.7% compared to 25.9% in implants (p=0.002), and 11.9% of native infections presented with a QSOFA score of ≥2 compared to 1.9% in implant-associated (p=0.028).
•Empirical and targeted antimicrobial choice including choice of oral switch and durations are outlined in table 2 and figure 1.
•Microbiological diagnosis was established in 84% of native cases and 87% of implant-associated infections with causative organisms in figure 2. Polymicrobial infection was more frequent in implant-associated compared to native infections, 25.9% versus 0.6% (p<0.001). Infection with AMR-organisms was more frequent in native infections compared to implants (8.8% versus 5.6%) but this was not statistically significant (p=0.57).
•Adverse events associated with antimicrobials (including line infections, line related thrombosis, diarrhoea/CDI and blood abnormalities) were encountered in 28.3% of native and 24.1% in implant-associated (p=0.547)
•Surgical management occurred in 32.1% of native, compared to 83.3% of implant-associated. 30/45 patients underwent DAIR, and 15/45 underwent removal of implant.
•Overall relapse rate was similar at 11.3% (native) and 11.1% (implants). Lower albumin levels at presentation was noted for patients who relapsed (25.33g/L versus 30.4g/L although the difference did not meet statistical significance (p=0.051). Relapse occurred in 4/30 patients managed with DAIR (13.3%) compared with 1/15 following implant removal (6.7%) (p=0.65). There was no significant difference in relapse in those receiving exclusive IV therapy (13.3%) versus patients with IVOS (10.4%) (p=0.664).
Conclusion:
The management of spinal infections is complex and associated with significant treatment burden, morbidity and mortality. Native infections presented with greater systemic inflammatory responses. Whereas implant-associated infections were more frequently polymicrobial. Our data supports that 6-week courses of antimicrobials are sufficient for native infections and oral switch is not associated with poorer outcomes although further analysis is ongoing. Next steps include quality improvement interventions focusing on antimicrobial stewardship and optimal tissue sampling, and further data analysis to gain a greater understanding of risk of relapse and mortality in native and implant-associated infections.
References
1.Tsantes AG, Papadopoulos DV, Vrioni G, et al. Spinal Infections: An Update. Microorganisms. 2020;8(4):476. Published 2020 Mar 27. doi:10.3390/microorganisms8040476
2.Skaf GS, Domloj NT, Fehlings MG, et al. Pyogenic spondylodiscitis: an overview. J Infect Public Health. 2010;3(1):5-16. doi:10.1016/j.jiph.2010.01.001
3.ljawadi A, Jahangir N, Jeelani A, et al. Management of Pyogenic Spinal Infection, review of literature. J Orthop. 2019;16(6):508-512. Published 2019 Aug 12. doi:10.1016/j.jor.2019.08.014
