title: Admission inflammatory markers and isolation of a causative organism in patients with spontaneous spinal infection.
abstract: BACKGROUND
  The purpose of this study was to investigate the significance of the inflammatory markers on admission in the isolation of a causative pathogen in patients with spinal infection. Spinal infection is treated frequently at spinal units and can encompass a broad range of clinical entities. Its diagnosis is often delayed because of the difficulty of identifying the responsible pathogen.
  
  
  METHODS
  Patients with spinal infection treated in our institution over a period of eight years were identified and their notes studied retrospectively. Admission C-reactive protein (CRP), white cell count (WCC) as well as co-morbidities and mode of pathogen identification were recorded. Overall, 96 patients were included in the study.
  
  
  RESULTS
  The CRP levels on admission were correlated significantly with the overall potential for isolation of a pathogen (p<0.0001) and positive biopsy cultures (p=0.0016). Admission WCC levels were associated significantly with the overall potential for isolation of a pathogen (p=0.0003) and positive biopsy cultures (p=0.0023). Both CRP and WCC levels were significantly negatively correlated with the duration of the preceding symptoms (p=0.0003 and p<0.0001 respectively). Delay in presentation was significantly negatively correlated with organism isolation (p=0.0001). Multivariate analyses identified the delay in presentation as the strongest independent variable for organism isolation (p=0.014) in cases of spontaneous spinal infection when compared with the admission CRP level (p=0.031) and WCC (p=0.056).
  
  
  CONCLUSIONS
  In spontaneous spinal infection, delay in presentation is the strongest independent variable for organism isolation. High inflammatory marker levels on admission are a useful prognostic marker for the overall potential of isolating a causative organism either by blood cultures or by biopsy in patients with negative blood cultures. Furthermore, the admission inflammatory marker levels allow for treating surgeons to counsel their patients of the likelihood of achieving a positive microbiological yield from biopsy.
authors.affiliation: North Bristol NHS Trust, Flat 12, Muller House, Ashley Down Road, Bristol BS7 9DA, UK. alextorrie99@hotmail.com.
authors.forename: P A G
authors.initials: PA
authors.lastname: Torrie
authors.forename: A
authors.initials: A
authors.lastname: Leonidou
authors.forename: I J
authors.initials: IJ
authors.lastname: Harding
authors.forename: G
authors.initials: G
authors.lastname: Wynne Jones
authors.forename: M J
authors.initials: MJ
authors.lastname: Hutchinson
authors.forename: I W
authors.initials: IW
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006094:Gram-Positive Bacteria / Q000302:isolation & purification*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000175:diagnosis* / Q000382:microbiology; D061665:Time-to-Treatment
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein