The Incidence, Pathogen Spectrum, and Resistance Profile of Pyogenic Spondylodiscitis: A Nationwide Retrospective Evaluation of G-DRG Data.

Abstract

BACKGROUND: Pyogenic spondylodiscitis is a type of infection of the spine whose incidence is rising in an aging, multimorbid population. The goal of this study is to analyze nationwide trends in Germany regarding the epidemiology, pathogen spectrum, and antimicrobial resistance profile of this disease over the period 2005-2023. METHODS: All hospital discharges were retrospectively analyzed with nationwide data on German Diagnosis Related Groups (G-DRG). Hospitalizations with a primary ICD-10-GM diagnosis of spinal osteomyelitis, a pyogenic intervertebral disc infection, or discitis, not otherwise specified (M46.2*, M46.3*, M46.4*) were included in the analysis. The age-adjusted incidence was calculated using population data from the Federal Statistical Office of Germany. Pathogen determinations and resistance phenotypes were ascertained from supplementary pathogen codes. RESULTS: 151 544 cases were identified. Over the study period, the age-adjusted incidence doubled (from 5.41 to 10.02 cases per 100 000 persons), the patients' mean age rose from 65.8 to 72.2 years, and the percentage of patients aged 70 or above rose from 42.6% to 62.3%. The mean length of hospital stay decreased, while in-hospital mortality doubled (from 3.25% to 6.79%). Over the same period, the rate of pathogen determination improved. The percentage of cases due to Staphylococcus aureus fell markedly (from 34.5% to 17.2%), while the percentage due to other gram-positive pathogens rose. The percentage of gram-negative pathogens remained stable. Resistant S. aureus isolates became rarer, while resistant Enterobacterales and Enterococci were identified more frequently. There was an overall downward trend in the rate of resistant pathogens in the final six years of the study period, from 14.1% in 2017 to 6.9% in 2023. CONCLUSION: In Germany, pyogenic spondyodiscitis mainly affects older patients, and the associated in-hospital mortality is rising. Changes in the pathogen spectrum and in resistance patterns indicate the need for corresponding adjustments to empirical treatment regimens.