Parakeratosis variegata: a possible role of environmental hazards?

AIM: To investigate how risk factors and reduced spinal mobility contribute to spinal infections arising from methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, known for increased mortality and diagnostic difficulties, especially in patients with septic shock or coma.

METHODS

This retrospective study divided MSSA bacteremia patients into three groups: spinal infections (Group A, n = 14), non-spinal/implant infections (Group B, n = 24), and implant-related infections (Group C, n = 21). Analyses focused on demographics, medical history, laboratory inflammatory markers at antibiotic initiation, and spinal pathologies detected by CT. All results of the statistical analyses were significant at P < 0.05. We employed multinomial univariable logistic regression and contingency table analysis to assess risk factors across three groups. Subsequently, binomial multivariable logistic regression was used to compare Group A against Groups B and C, successfully identifying significant predictors of spinal infection.

RESULTS

A lower incidence of diabetes (p = 0.029), higher C-reactive protein (CRP) levels at onset (p = 0.014), and the presence of diffuse idiopathic skeletal hyperostosis (diffuse idiopathic skeletal hyperostosis (DISH); p = 0.022) were significantly associated with spinal infections in Group A. Furthermore, binomial analysis revealed DISH (Odds Ratio (OR) = 41.750; 95% Confidence Interval (CI) [1.86-939.0]; p = 0.019), absence of diabetes (OR = 1.20, CI [1.01-1.43], p = 0.038), elevated CRP (OR = 23.34, CI [1.13-483.4], p = 0.042), and a lower day 3/day 1 white blood cell (WBC) ratio (OR = 0.964, CI [0.93-1.00], p = 0.047) as risk factors when compared with other groups.

CONCLUSION

Spinal infection patients with MSSA bacteremia are less likely to have diabetes and more likely to have higher initial CRP levels and DISH. Notably, DISH might be emerging as a distinctive risk factor for spinal infection, underscoring its potential as a marker for clinical awareness.