Age- and Site-Dependent Pathogens in Spondylodiscitis: A Study of 10,801 Cases.

Authors

Nicolas Heinz von der Hoeh, Melanie Ardelt, Max Joseph Scheyerer, Christian Herren, Andreas Kramer, Sigmund Lang, Spine Section of the German Society for Orthopaedics and Trauma (AG Spondylodiscitis)

Published in

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. Pages 109137. Sep 23, 2026. Epub Sep 23, 2026.

Abstract

Pyogenic spondylodiscitis (PSD) is a life-threatening infection with increasing incidence in aging populations. This study investigates age- and localization-dependent shifts in the pathogen spectrum to provide an epidemiological basis for empiric antimicrobial therapy.
We conducted a retrospective analysis of German nationwide hospital discharge data from 2024 (InEK), including 10,801 PSD cases. Patients were stratified by age (<65, 65-79, and ≥80 years) and spinal localization (cervical, thoracic, lumbar, and multisegmental).
Overall in-hospital mortality was 7.1% (with an unadjusted weighted average of 6.4% across age-stratified subgroups). The prevalence of Staphylococcus spp. declined with increasing age (35.7% to 21.3%; p<0.001), whereas Enterococcus spp. (3.9% to 11.8%) and Enterobacterales (17.3% to 21.4%) increased (p<0.001). Lumbar infections showed a significantly higher prevalence of Enterobacterales (28% among pathogen-positive cases) and Enterococcus spp. (13% among pathogen-positive cases) compared to cervical sites (p<0.001).
In a large-scale nationwide cohort, pathogen distribution in PSD is moderately associated with patient age and spinal localization. While confirming previously described trends, these population-based findings reinforce that uniform empiric antimicrobial regimens may inadequately cover the risk profile in elderly patients with lumbar manifestations.

PMID:
42778058
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

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