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Case Reviews of Infections of the Spine in Patients With a History of Solid Organ Transplantation

Falakassa, Jonathan MD; Hirsch, Brandon P. MD; Norton, Robert P. MD; Mendez-Zfass, Matthew MD; Eismont, Frank J. MD

doi: 10.1097/BRS.0000000000000453
Clinical Case Series

Study Design. Retrospective clinical case series.

Objective. To report on the epidemiological, microbiological, and clinical characteristics of spinal infections in patients who have undergone solid organ transplantation.

Summary of Background Data. Spine infections remain a therapeutic challenge, particularly in patients who are immunocompromised. Solid organ transplant patients represent a growing population of immunocompromised hosts. To our knowledge, no previous reports have examined the clinical characteristics spinal infections in this at-risk population in a systematic fashion.

Methods. The records of patients with a history of solid organ transplantation from January 2007 through December 2012 were identified using Current Procedural Terminology procedure codes. Patients with spine infections who have received transplants were then identified using International Classification of Diseases, Ninth Revision codes for spine infection. In addition to demographic data, we recorded medical comorbidities, immunosuppressant medications, laboratory results, culture data, treatment received, and short-term results.

Results. During this 6-year period, 2764 solid organ transplants were performed at our institution. Of this cohort, 6 patients (0.22%) were treated for a spinal infection. Patient's age ranged from 51 to 80 years (mean, 63 yr). All spine infections occurred within 1 year after organ transplantation. All patients had an elevated erythrocyte sedimentation rate. Only 1 patient had an elevated white blood cell count. The most common organisms were Escherichia coli and Staphylococcus. Four patients required surgical treatment. All patients had complete resolution of symptoms.

Conclusion. Our data suggest that patients with a history of solid organ transplantation may be more susceptible to developing spine infections than the general population. The most common organisms in our cohort were E. coli and Staphylococcus. Spine infections caused by atypical organisms do also occur in the organ transplant population, as is the case in other immunocompromised patients. The identification of these organisms and timely institution of treatment remains critical in the management of this at-risk population.

Level of Evidence: 4

Spinal infections in immunocompromised patients remain a diagnostic and therapeutic challenge. Timely, accurate identification of an organism is crucial to successful treatment. We present the clinical and microbiological characteristics of a series of patients at our institution with a history of solid organ transplant and subsequent spinal infection.

From the Department of Orthopaedics, Jackson Health System/University of Miami, Miami, FL.

Address correspondence and reprint requests to Jonathan Falakassa, MD, Department of Orthopaedics, Jackson Health System/University of Miami, 1611 NW 12th Ave R303, Miami, FL 33136; E-mail:

Acknowledgment date: January 4, 2014. Revision date: March 28, 2014. Acceptance date: May 22, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, patents, royalties, payment for development of educational presentations, and stock/stock options.

© 2014 by Lippincott Williams & Wilkins