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The Etiology, Clinical Presentation and Long-term Outcome of Spondylodiscitis in Children

Kang, Hyun Mi MD; Choi, Eun Hwa MD; Lee, Hoan Jong MD; Yun, Ki Wook MD; Lee, Choon-Ki MD; Cho, Tae-Joon MD; Cheon, Jung-Eun MD; Lee, Hyunju MD

The Pediatric Infectious Disease Journal: April 2016 - Volume 35 - Issue 4 - p e102–e106
doi: 10.1097/INF.0000000000001043
Original Studies
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Background: Spondylodiscitis (SD) is a rare disease in children and diagnosis can be delayed because of the scarcity in incidence and lack of awareness. The purpose of this study was to evaluate and report the microbiologic epidemiology and clinical features of pediatric SD in South Korea.

Methods: This was a retrospective study of children <19 years old admitted for the treatment of SD between 2000 and 2014. Electronic medical records were reviewed for clinical parameters and etiologic agents.

Results: During the 15-year period, 25 patients were diagnosed with SD. The median age was 13.8 years, and 60% were male. Back pain was the most common presenting symptom (n = 17; 68%), and only 52% (n = 13) of the patients had a history of fever (≥38.0°C). In patients younger than 3 years, irritability (n = 5; 62.5%) was the most predominant symptom. Microorganisms were isolated in 22 cases, the most common being Staphylococcus aureus (40%) and Mycobacterium tuberculosis (32%). Of the 25 patients, 64% (n = 16) had blood cultures taken, 56% (n = 14) underwent percutaneous fluoroscopy-guided biopsy, and 48% (n = 12) underwent open surgical biopsy. The positive rate for microbiologic diagnosis of each method was 18.8% (n = 3) for blood culture, 71.4% (n = 10) for percutaneous biopsy and 100% (n = 12) for surgical biopsy. Overall, 52% (n = 13) needed surgical treatment along with antibiotic therapy. Patients who needed surgery had a significant delay in diagnosis compared with those that did not (median, 60 vs. 31 days; P = 0.014).

Conclusions: S. aureus and M. tuberculosis are the predominant causes of SD in children in South Korea. Obtaining tissue culture is important to confirm the bacterial etiology of the infection and appropriately guide antibiotic therapy in a community in which the endemic organisms require treatment pathways that are widely divergent.

From the *Department of Pediatrics, Division of Pediatric Orthopaedics, Department of Pediatric Radiology, Seoul National University Children’s Hospital, Seoul, Republic of Korea; and §Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea.

Accepted for publication September 14, 2015.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Hyunju Lee, MD, Department of Pediatrics, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam, Gyeonggi-Do 463–707, Republic of Korea. E-mail: mdopd@hanmail.net; hyunjulee@snubh.org

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