title: Comparison of gram-negative and gram-positive hematogenous pyogenic spondylodiscitis: clinical characteristics and outcomes of treatment.
abstract: To the best of our knowledge, no study has compared gram-negative bacillary hematogenous pyogenic spondylodiscitis (GNB-HPS) with gram-positive coccal hematogenous pyogenic spondylodiscitis (GPC-HPS) regarding their clinical characteristics and outcomes.
  
  
  
  From January 2003 to January 2013, 54 patients who underwent combined antibiotic and surgical therapy in the treatment of hematogenous pyogenic spondylodiscitis were included.
  
  
  
  Compared with 37 GPC-HPS patients, the 17 GNB-HPS patients were more often found to be older individuals, a history of cancer, and a previous history of symptomatic urinary tract infection. They also had a less incidence of epidural abscess formation compared with GPC-HPS patients from findings on magnetic resonance imaging (MRI). Constitutional symptoms were the primary reasons for initial physician visits in GNB-HPS patients whereas pain in the affected spinal region was the most common manifestation in GPC-HPS patients at initial visit. The clinical outcomes of GNB-HPS patients under combined surgical and antibiotic treatment were not different from those of GPC-HPS patients. In multivariate analysis, independent predicting risk factors for GNB-HPS included a malignant history and constitutional symptoms and that for GPC-HPS was epidural abscess.
  
  
  
  The clinical manifestations and MRI presentations of GNB-HPS were distinguishable from those of GPC-HPS.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia Pu Rd., PuTz, Chiayi, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Taipei Medical University Hospital, Taipei, Taiwan.|Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Meng-Huang
authors.initials: MH
authors.lastname: Wu
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia Pu Rd., PuTz, Chiayi, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chin-Chang
authors.initials: CC
authors.lastname: Cheng
authors.affiliation: Department of Orthopedic Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Tsung-Jen
authors.initials: TJ
authors.lastname: Huang
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Tsung-Yu
authors.initials: TY
authors.lastname: Huang
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia Pu Rd., PuTz, Chiayi, Taiwan.
authors.forename: Chien-Yin
authors.initials: CY
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.|Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.
authors.forename: Jou-Chen
authors.initials: JC
authors.lastname: Huang
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Chia Pu Rd., PuTz, Chiayi, Taiwan. orthoejaca@gmail.com.|College of Medicine, Chang Gung University, Taoyuan, Taiwan. orthoejaca@gmail.com.
authors.forename: Yen-Yao
authors.initials: YY
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015299:Discitis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gram-negative infection; Gram-positive infection; Hematogenous pyogenic spondylodiscitis