Clinical characteristics and surgical outcomes of spinal infections in intravenous drug users and nonintravenous drug users.

Abstract

Intravenous drug use (IVDU) is a significant risk factor for spinal infections. However, spinal infection in IVDU patients compared to Non-IVDU remains poorly described in the literature. To assess the characteristics, surgical outcomes, and complications of spinal infections in patients IVDU and Non-IVDU patients. Retrospective observational cohort. Consecutive series of patients who underwent surgery for spinal infections, including spondylodiscitis, epidural abscess, and facet joint septic arthritis at a single multisurgeon tertiary institution. postoperative complications, causative pathogens, recurrence rates. We retrospectively reviewed consecutive patients who underwent surgery for spinal infections, including spondylodiscitis, epidural abscess, and facet joint septic arthritis. Demographics, comorbidities, causative pathogens, and postoperative complications were compared between IVDU and Non-IVDU patients. Among 255 patients, 88 (35%) were IVDU. Compared to Non-IVDU patients, they were significantly younger (47.2±10.3 vs. 59.6±13.4 years, p<.001) and had a lower BMI (26.6±5.9 vs. 29.7±8.7, p=.001) but a lower incidence of diabetes (16% vs. 52%, p<.001), steroid use (0% vs. 9%, p=.002), and chronic kidney disease (9% vs. 29%, p≤.001). While the lumbar spine was the most commonly affected region, followed by the thoracic spine, cervical spine infection was significantly more frequent in IVDU patients (19% vs. 8%, p=.013). Additionally, concomitant endovascular infections were more commonly observed in IVDU patients (19% vs. 8%, p=.015). As causative pathogens, MRSA and Serratia were significantly more prevalent in IVDU patients (MRSA; 50% vs. 27%, p<.001, Serratia; 10% vs. 0%, p<.001). IVDU patients had significantly higher rates of readmission (67% vs. 46%, p=.002) and complication rates within 1 year, including spinal infection recurrence (20% vs. 6%, p=.001), endovascular infections (17% vs. 5%, p=.006), and uncontrolled pain (26% vs. 0%, p<.001). IVDU (OR=2.94, 95% CI: 1.24-7.24, p=.016) was independently associated with treatment failure, defined as recurrence or mortality. Compared to Non-IVDU patients, IVDU patients had higher rates of cervical spine involvement, concomitant endovascular endocarditis, and MRSA and Serratia infection, as well as increased readmissions and complications, including recurrence, endovascular infections, and uncontrolled pain.