Abstract：
OBJECTIVE: To date, there are no standardized treatment algorithms or recommendations for patients with infective endocarditis (IE) and concomitant spondylodiscitis (SD). Therefore, our aim was to analyse whether the sequence of surgical treatment of IE and SD has an impact on postoperative outcome and to identify risk factors for survival and postoperative recurrence.
METHODS: Patients with IE underwent surgery in 4 German university hospitals between 1994 and 2022. Univariable and multivariable analyses were performed to identify possible predictors of 30-day/1-year mortality and recurrence of IE and/or SD.
RESULTS: From the total IE cohort (n = 3991), 150 patients (4.4%) had concomitant SD. Primary surgery for IE was performed in 76.6%, and primary surgery for SD in 23.3%. The median age was 70.0 (64.0-75.6) years and patients were mostly male (79.5%). The most common pathogens detected were enterococci and Staphylococcus aureus followed by streptococci, and coagulase-negative Staphylococci. If SD was operated on first, 30-day mortality was significantly higher than if IE was operated on 1st (25.7% vs 11.4%; P = 0.037) and we observed a tendency for a higher 1-year mortality. If IE was treated 1st, we observed a higher recurrence rate within 1 year (12.2% vs 0%; P = 0.023). Multivariable analysis showed that primary surgery for SD was an independent predictor of 30-day mortality.
CONCLUSIONS: Primary surgical treatment for SD was an independent risk factor for 30-day mortality. When IE was treated surgically 1st, the recurrence rate of IE and/or SD was higher.
METHODS: Patients with IE underwent surgery in 4 German university hospitals between 1994 and 2022. Univariable and multivariable analyses were performed to identify possible predictors of 30-day/1-year mortality and recurrence of IE and/or SD.
RESULTS: From the total IE cohort (n = 3991), 150 patients (4.4%) had concomitant SD. Primary surgery for IE was performed in 76.6%, and primary surgery for SD in 23.3%. The median age was 70.0 (64.0-75.6) years and patients were mostly male (79.5%). The most common pathogens detected were enterococci and Staphylococcus aureus followed by streptococci, and coagulase-negative Staphylococci. If SD was operated on first, 30-day mortality was significantly higher than if IE was operated on 1st (25.7% vs 11.4%; P = 0.037) and we observed a tendency for a higher 1-year mortality. If IE was treated 1st, we observed a higher recurrence rate within 1 year (12.2% vs 0%; P = 0.023). Multivariable analysis showed that primary surgery for SD was an independent predictor of 30-day mortality.
CONCLUSIONS: Primary surgical treatment for SD was an independent risk factor for 30-day mortality. When IE was treated surgically 1st, the recurrence rate of IE and/or SD was higher.
摘要：
目标：迄今为止，对于感染性心内膜炎(IE)和伴发脊椎盘炎(SD)患者,目前尚无标准化治疗算法或建议.因此,我们的目的是分析IE和SD的手术治疗顺序是否对术后结局有影响,并确定生存和术后复发的危险因素.
方法：1994年至2022年之间，IE患者在4家德国大学医院接受了手术。进行单变量和多变量分析，以确定可能的预测因素30天/1年死亡率和复发IE和/或SD。
结果：从总IE队列（n=3991），150例患者（4.4%）合并SD。76.6%的人进行了IE的主要手术，和原发性手术的SD为23.3％。中位年龄为70.0[64.0-75.6]岁，患者多为男性（79.5%）。最常见的病原菌是肠球菌和金黄色葡萄球菌，其次是链球菌。和凝固酶阴性葡萄球菌(CoNS)。如果首先对SD进行手术，30天死亡率显着高于首次进行IE手术（25.7％vs11.4％；p=0.037），并且我们观察到1年死亡率较高的趋势。如果IE首先被治疗，我们观察到1年内复发率较高(12.2%vs0%;p=0.023).多变量分析表明，SD的初次手术是30天死亡率的独立预测因素。
结论：初次手术治疗SD是30天死亡率的独立危险因素。当IE首先接受手术治疗时，IE和/或SD的复发率较高。
方法：1994年至2022年之间，IE患者在4家德国大学医院接受了手术。进行单变量和多变量分析，以确定可能的预测因素30天/1年死亡率和复发IE和/或SD。
结果：从总IE队列（n=3991），150例患者（4.4%）合并SD。76.6%的人进行了IE的主要手术，和原发性手术的SD为23.3％。中位年龄为70.0[64.0-75.6]岁，患者多为男性（79.5%）。最常见的病原菌是肠球菌和金黄色葡萄球菌，其次是链球菌。和凝固酶阴性葡萄球菌(CoNS)。如果首先对SD进行手术，30天死亡率显着高于首次进行IE手术（25.7％vs11.4％；p=0.037），并且我们观察到1年死亡率较高的趋势。如果IE首先被治疗，我们观察到1年内复发率较高(12.2%vs0%;p=0.023).多变量分析表明，SD的初次手术是30天死亡率的独立预测因素。
结论：初次手术治疗SD是30天死亡率的独立危险因素。当IE首先接受手术治疗时，IE和/或SD的复发率较高。
