Clinical Outcomes and Challenges in the Management of Spondylodiscitis in Patients With Intravenous Drug Abuse: A Multicenter Retrospective Study

TL;DR

This study compares outcomes of spondylodiscitis in intravenous drug users and non-users, finding that drug users have higher relapse rates despite younger age and fewer comorbidities.

Contribution

The study provides new insights into the clinical management of spondylodiscitis in intravenous drug users, challenging assumptions about infection severity.

Findings

IVDU patients with spondylodiscitis are younger and have fewer comorbidities than non-IVDU patients.

IVDU patients have higher relapse and progression rates despite similar bacterial spectrum and comparable revision surgery rates.

Cure rates at 10 weeks are significantly lower in IVDU patients compared to non-IVDU patients.

Abstract

Retrospective multicenter study.

To examine the epidemiology and clinical outcomes of spondylodiscitis in patients with intravenous drug abuse (IVDU) and compare them with non-IVDU patients.

Data from 575 patients diagnosed with spondylodiscitis between 1 January 2018 and 31 December 2023 from three high-volume spine centers was analyzed. Of these, 33 (5.74%) were patients with IVDU, and 542 (94.26%) were non-IVDU patients. Clinical characteristics, bacterial spectrum, and treatment outcomes, including revision surgery rates and cure rates, were compared.

Patients with IVDU were significantly younger (mean age 43.9 ± 9.1 years) compared to non-IVDU patients (mean age 70.5 ± 11.9 years) (P < .0001). The median Charlson Comorbidity Index (CCI) was significantly lower in IVDU patients (1, IQR: 0-3) compared to non-IVDU patients (4, IQR: 3-6) (P < .0001). The bacterial spectrum was similar between both groups, with Staphylococcus aureus as the most frequent pathogen. Revision surgery rates were comparable; however, among patients requiring revision, recurrent or progressive discitis was more frequently the cause in IVDU patients (55.6%) compared to non-IVDU patients (17.9%). At 10-week follow-up, 87.9% of non-IVDU patients were cured, while only 57.9% of IVDU patients achieved a cure (P = .0018).

IVDU patients with spondylodiscitis are younger and have fewer comorbidities than non-IVDU patients. Contrary to common assumptions, they do not present with more severe infections. However, they experience higher relapse and progression rates, highlighting the need for tailored treatment strategies in this high-risk group.

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