Spondylitis: A Frequent And Severe Complication Of Infective Endocarditis

Spondyslodiscitis (SP) is a rare but severe complication of infective endocarditis (IE). The indicence, clinical features and prognosis of SP in IE are unknown. The primary objective of our study was to assess the incidence, epidemiology, clinical presentation, prognosis and therapeutic implications of SP in patient with IE. The secondary objectives were to assess factors associated with occurrence of spondylitis and to assess the value of imaging techniques. In a French bi-center prospective study of patients who presented in our endocarditis reference centers with a diagnosis of definite IE from 1990 to 2018 (n = 1755), 150 (8.5%) presented with SP. Patients were divided in two groups for the analysis: patients with (n = 150) and without (n = 1605) SP. Patients with SP were older (mean age 69 ± 18 vs. 66 ± 14, P = 0.004), had more arterial hypertension (48% vs. 33%, P < 0.001) and autoimmune disease (5% vs. 2%, P = 0.003) than patients without SP. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L3-L4. Neurological symptoms were observed in 59% of patients. Enterococci and Gallolyticus streptococci were more frequent (24% vs. 12% and 24% vs. 11%, P < 0.001, respectively) in the SP group. Observed sensitivities of full spine contrast-enhanced MRI and CT were 95% and 89%, respectively. PET/CT had a great power to differentiate infective to degenerative vertebral processes, and to find embolic foci with a sensitivity of 90%. Clinical outcome did not differ between patients with or without SP, incliding similar in-hospital mortality (16% vs. 14%, P = 0.38). We describe the largest ever reported series of patients with SP complicating IE. SP is a more frequent complication of IE than previously reported but has similar prognosis than other forms of IE. Multimodality imaging including MRI, CT and PET/CT should be used for early diagnosis of this IE complication.