title: The clinical characteristics, therapeutic outcome, and prognostic factors of non-tuberculous bacterial spinal epidural abscess in adults: a hospital-based study.
abstract: OBJECTIVE
  Nontuberculous bacterial spinal epidural abscess (SEA) is a serious infectious disease of spines. Despite proper management, SEA remains a disease of high morbidity. The epidemiological data in southern Taiwan is still lacking.
  
  
  METHODS
  We analyzed the clinical features, laboratory data, magnetic resonance imaging findings, and therapeutic results of 45 bacterial SEA patients, collected during a study period of six years (2003- 2008).
  
  
  RESULTS
  The 45 adult SEA patients, 32 were men and 13 women, aged 17-81 years (mean = 62 years). Thoracic and lumbosacral spines were the most commonly affected segments. Staphylococcus aureus was the most commonly implicated pathogen, accounting for infections in 67% (29/43) of the culture-proven cases, and 41% (12/29) of the S. aureus strains were oxacillin resistant. Gram-negative pathogens were implicated in 30% (13/43) of the culture-proven cases. Of the 45 patients, 19 underwent antibiotic treatment alone and 26 underwent medical and surgical treatments. The therapeutic results showed that 28 patients had a good prognosis and 17 had a poor prognosis. The significant prognostic factors included higher age, presence of diabetes mellitus and chronic heart disease, and initial presentation of altered consciousness.
  
  
  CONCLUSIONS
  S. aureus was the most commonly implicated pathogen of adult SEA, and most S. aureus strains were oxacillin resistant. A relatively high incidence of Gram-negative infection was observed in this study. The epidemiological characteristics of the implicated pathogens must receive special consideration when selecting the empirical antibiotics. Despite adequate management, many adults with bacterial SEA had a high incidence of poor prognosis.
authors: Department of Neurology, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors: Shang-Hang
authors: SH
authors: Chen
authors: Wen-Neng
authors: WN
authors: Chang
authors: Cheng-Hsien
authors: CH
authors: Lu
authors: Yao-Chung
authors: YC
authors: Chuang
authors: Chun-Chung
authors: CC
authors: Lui
authors: Shu-Fang
authors: SF
authors: Chen
authors: Nai-Wen
authors: NW
authors: Tsai
authors: Chung-Chih
authors: CC
authors: Chang
authors: Chun-Chih
authors: CC
authors: Chien
authors: Chi-Ren
authors: CR
authors: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D020802:Epidural Abscess / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology* / Q000628:therapy*; D004824:Epidural Space / Q000382:microbiology* / Q000473:pathology; D005260:Female; D006761:Hospitals; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000472:pathogenicity*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents