title: The Etiology, Clinical Presentation and Long-term Outcome of Spondylodiscitis in Children.
abstract: 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.
authors.affiliation: 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.
authors.forename: Hyun Mi
authors.initials: HM
authors.lastname: Kang
authors.forename: Eun Hwa
authors.initials: EH
authors.lastname: Choi
authors.forename: Hoan Jong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Ki Wook
authors.initials: KW
authors.lastname: Yun
authors.forename: Choon-Ki
authors.initials: CK
authors.lastname: Lee
authors.forename: Tae-Joon
authors.initials: TJ
authors.lastname: Cho
authors.forename: Jung-Eun
authors.initials: JE
authors.lastname: Cheon
authors.forename: Hyunju
authors.initials: H
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use; D015415:Biomarkers; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D015299:Discitis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008828:Microbiological Techniques; D063868:Patient Outcome Assessment; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D000890:Anti-Infective Agents; D015415:Biomarkers