|Tipo di tesi||Tesi di dottorato di ricerca|
|Titolo||EPIDEMIOLOGIA E CARATTERISTICHE CLINICHE DI PAZIENTI ADULTI AFFETTI DA SPONDILODISCITE SU VERTEBRA NATIVA AFFERENTI IN UN OSPEDALE UNIVERSITARIO MODENESE DI TERZO LIVELLO NEL PERIODO 2007-2018 E RUOLO DELLA 18F-FDG TOMOGRAFIA AD EMISSIONE DI POSITRONI/TOMOGRAFIA COMPUTERIZZATA (PET/CT) COME STRUMENTO DI VALUTAZIONE DELL'OUTCOME CLINICO IN FACE PRECOCE DI TRATTAMENTO|
|Titolo in inglese||EPIDEMIOLOGY AND CLINICAL CHARACTERISTICS OF ADULT PATIENTS WITH NATIVE VERTEBRAL OSTEOMYELITIS IN A TERTIARY-CARE UNIVERSITY HOSPITAL IN MODENA BETWEEN 2007-2018 AND ROLE OF 18F-FDG POSITRON EMISSION TOMOGRAPHY/COMPUTERIZED TOMOGRAPHY (PET/CT) AS AN ASSESSMENT TOOL OF CLINICAL OUTCOME AT EARLY STAGE OF TREATMENT|
|Settore scientifico disciplinare||MED/17 - MALATTIE INFETTIVE|
|Corso di studi||CLINICAL AND EXPERIMENTAL MEDICINE (CEM) - MEDICINA CLINICA E SPERIMENTALE|
|Data inizio appello||2019-09-13|
|Disponibilità||Accessibile via web (tutti i file della tesi sono accessibili)|
Introduzione e scopi: L’osteomielite su vertebra nativa (NVO) è una patologia rara ma potenzialmente grave. In Italia vi sono pochi dati sistematicamente raccolti riguardanti l’epidemiologia e l’approccio clinico di questa patologia. Nonostante vi siano dal 2015 linee guida internazionali riguardanti la gestione della NVO, vi sono ancora aspetti da chiarire come l’utilità dei markers infiammatori e della diagnostica nucleare nello stabilire la guarigione clinica nel follow-up. Dal 2012 la Clinica di Malattie Infettive del Policlinico di Modena si avvale della tomografia ad emissione di positroni con 18F-fluoro-desossi-glucosio/tomografia computerizzata (PET/CT) nell’algoritmo gestionale dei pazienti con NVO. L’obiettivo primario dello studio è stato descrivere l’epidemiologia della NVO in provincia di Modena negli anni 2007-2018 e le caratteristiche cliniche, microbiologiche e di cura. L’obiettivo secondario è stato quello di valutare il ruolo della PET/CT e della proteina C reattiva (CRP) nel predire in fase precoce la guarigione.
Background and Aims: Native vertebral osteomyelitis (NVO) or spondylodiscitis is a rare but a potentially serious disease with long-term sequelae. Due to the lack of a national or regional Register, epidemiological and management data about NVO in Italy are scarce. Notwithstanding internationally acknowledged guideline on diagnosis and treatment are available since 2015, unsolved issues remains under many aspects. In particular, is still not clear the role of inflammatory markers and nuclear imaging in defining clinical cure during the follow-up. Starting from 2012 we introduced at Infectious Disease Clinic in Modena, together with magnetic resonance imaging (MRI), 18F-fluorodeoxyglucose positron emission tomography (PET/CT) scan in the management algorithm of bacterial NVO. The first aim of the study was to evaluate the epidemiological trend of NVO in adults in Modena province during the years 2007-2018 and to describe the clinical, microbiological and outcome characteristics. The second aim was to evaluate the role of PET-CT scan and C-Reactive Protein (CRP) in predicting at early phase the outcome of patients with NVO. Materials and methods: We performed a retrospective and prospective since 2018, observational study enrolling patients with diagnosis of bacterial NVO referring to ID Clinic in Modena (inpatients, consultancy activity and the Bone Outpatient Clinic). Data collected were: demographic data; past medical history; biopsies, abscess and blood cultures results; PET/CT SUVmax value at baseline and at follow-up, CRP values at 0,15,30,45,60 days. Usefulness of PET and CRP was evaluated comparing ΔSUV% ≤ or > 25% from baseline and ΔCRP% from baseline at week 2 and in the following weeks between the groups of patients “cured” and “not cured”. Results: NVO incidence significantly increased during time comparing 2007-2010 with 2011-2014 and 2015-2017 period (IRR= 4.76 and IRR=5.91, p<0.001 respectively) with no variation in mean age or sex during the study period. 60.3% patients were males; 2-years mortality was 11.4%; 64.0% patients were considered clinically cured with no differences in cure rates over the years (p per trend= 0.730). Microbiological identification was obtained in 85/114 NVO cases (74.6%): methicillin-susceptible S.aureus was the most common organism isolated (25.8% of cases); M.tuberculosis accounted for 17 (14,9%) cases, all strains were rifampin-susceptible. Sixty-two patients had a baseline PET/CT cases; a first analysis including 28 non-tubercular NVO cases with a baseline and a week 2 PET/CT showed no significant differences in PET variations; same results were obtained in a second analysis of 48 patients with 2 consecutive PET. Mean SUV decline was 18.5% in the not cured group and 27.7% in the cured group (p= 0.445); a significant SUV variation over time was found in patients with unknown NVO (p<0.003) but not in gram-positive or gram-negative NVO group. SUVmax decline and ΔSUV% change ≤ or > 25% from baseline did not correlate with antimicrobial duration of therapy (p=0.438 and p=0.544 respectively). Similarly, CRP decline over time did not differ among “cured” and “not cured” patients (p=0.979). Conclusion: During the study period an increasing trend of NVO was observed in Modena province. ΔSUV% and ΔCRP% decline during follow-up demonstrate a scarce accuracy in predicting clinical outcome in NVO. SUVmax change may have a role in the management in the sub-group of NVO patients without microbiological identification.