A 10-years study of vertebral osteomyelitis in Hamadan, West of Iran

Epidemiology and predisposing factors of spondylodiscitis or vertebral osteomyelitis are different in different populations. This study was conducted to delineate the epidemiology and microbiological status of in Hamedan, Iran.
In this retrospective study, all patients with definite diagnosis of spondylodiscitis (changing of intervertebral disc and adjacent vertebral MRI signal) hospitalized in Besat and Farshchian Hospitals of Hamedan between 2006 and 2015 (during 10 years) were enrolled by convenience sampling. Data on age, gender, underlying disease, constitutional symptoms, place of acquiring infection, leukocytosis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), surgical intervention, vertebral biopsy culture, anemia, abscess, place of vertebral involvement, positive brucellosis test, and blood culture results were obtained from the patients’ medical files and recorded in a questionnaire.
A total of 71 patients with spondylodiscitis (mean age: 49.56 years) were enrolled. Brucella (n: 27, 38%) was the leading cause of the disease followed by tuberculosis (n: 11, 15.5%). Although 34 patients had positive serologic test for Brucella, other agents were causes of the disease according to course of treatment and vertebral biopsy in 7 of them. In 21 cases, the cause of the disease was unknown. The most common place of involvement was lumbosacral region (78.9%).
Unlike Infectious Diseases Society of America (IDSA) guideline that do not recommend to perform age-guided aspiration biopsy in suspected cases of spondylodiscitis when Brucella is endemic and whereby people have strong positive serology, our results demonstrated that, even in case of positive Brucella test, other factors are likely to contribute to acquiring spondylodiscitis, and vertebral biopsy is recommended for definite diagnosis. Early diagnosis is necessary to select appropriate antibiotic and treat spondylodiscitis early.