POS1283 SPONDILODISCITIS WITHOUT DOCUMENTED GERM: WHAT THERAPEUTIC MANAGEMENT?

Background: Spondylodiscitis (SD) is an infectious inflammation that affects the vertebrae, vertebral discs and adjacent structures. It may have a bacterial or non-bacterial etiology. Although analysis has improved and identification of pathogens is highly pursued, in one third of cases, no organism can be identified. Objectives: The objective of our work is to describe the epidemiological, clinical and evolutionary profile of SD with no germ identified and management. Methods: This is a retrospective study including 37 cases of SD with no germ identified, collected in the Rheumatology Department of Farhat Hached hospital in Sousse, Tunisia over a period of 22 years (1998-2020). Results: The mean age was 59.7 years [18-97 years]. These were 21 men (56.76 %) and 16 women (43.24 %).Spinal pain was the major symptom. The lumbar location was the most frequent in 56.76% of cases. It was a multifocal localization in 21.62%. The imaging allowed the detection of para abscesses -vertebral in 43.24%. An epiduritis was objectified in 54.05%.CT-guided biopsy was performed in 59.46% and it was not conclusive. A bacteriological survey was carried out and came back negative. Spondylodiscitis was presumed to be tubercular and staphylococcal in respectively 62.16 % and 18.92 %. The tuberculosis origin was retained in view of the chronic evolution, the multi-stage damage in the radiological assessment. While staphylococcal SD was retained due to the presence of cutaneous lesion and subacute evolution. Large-spectrum antibiotic therapy was initiated in the other cases.One case was initially considered to be staphylococcal but with epidural and soft tissue extension tuberculosis was then considered to be the cause. The evolution after initiation of adequate antibiotic treatment was interspersed with neurological complications in one case of tuberculosis SD. Conclusion: Our results show a higher frequency of presumed tuberculosis SD considering the endemicity of our country and the improvement under anti tuberculosis treatment. References: [1]Cornett, C. A., and al. Bacterial Spine Infections in Adults. Journal of the American Academy of Orthopaedic Surgeons, 24(1), 11–18.(2016) [2]Lener, S., and al Management of spinal infection: a review of the literature. Acta Neurochirurgica, 160(3), 487–496.(2018) [3]Homagk, L., and al SponDT (Spondylodiscitis Diagnosis and Treatment): spondylodiscitis scoring system. Journal of Orthopaedic Surgery and Research, 14(1).(2019) Disclosure of Interests: None declared