{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:29:28Z","timestamp":1787923768039,"version":"build-2784847793"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize the clinical, radiological, and microbiological features of pyogenic spondylitis (PS) and to describe outcomes observed within a severity-stratified real-world management pathway integrating antimicrobial therapy, stabilization, debridement, and fusion according to structural instability and neurological risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational cohort study of 149 patients with PS treated at Ningxia Medical University General Hospital between January 2015 and December 2023. Patients were retrospectively grouped according to baseline structural severity, neurological status, and the management strategy actually used in routine care: Group A, antimicrobial therapy plus external immobilization (n = 48); Group B, posterior fixation and fusion plus antimicrobial therapy (n = 57); and Group C, posterior fixation with debridement and fusion via posterior and\/or anterior approaches plus antimicrobial therapy (n = 44). Clinical characteristics, microbiological findings, inflammatory markers, VAS, ODI, Cobb angle, perioperative variables, complications, and endpoint-defined recovery were analyzed. Principal-component analysis and adjusted response models were prespecified as exploratory analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The three groups represented distinct severity strata, ranging from structurally stable disease to destructive disease with neurological compromise. Final diagnostic adjudication identified 73 microbiologically confirmed cases, whereas the prespecified patient-level yield analysis was limited to a 66-case interpretable pretreatment subset, within which positivity was lower in Group C than in Groups A and B (40.0% vs 82.4% and 84.2%, respectively; P\u00a0=\u00a00.001). At the specimen level, 95 bacterial isolate records were summarized, and\n                      <jats:italic>S. aureus<\/jats:italic>\n                      was the predominant isolate (48\/95). All groups showed improvement in inflammatory, pain, functional, and radiological measures over follow-up, although the tempo of recovery differed across severity-matched management strata. Exploratory adjusted analyses were directionally consistent with these descriptive patterns but should be interpreted cautiously.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this retrospective real-world cohort, a severity-stratified management pathway for PS was feasible and showed coherent microbiological, inflammatory, functional, and radiological recovery patterns within each clinical stratum. These findings support pragmatic escalation according to structural instability and neurological risk, but they should not be interpreted as comparative evidence of treatment superiority.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1883513","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T12:52:21Z","timestamp":1787921541000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical characteristics, microbiological landscape, and severity-stratified management of pyogenic spondylitis: a retrospective cohort study"],"prefix":"10.3389","volume":"16","author":[{"given":"Zongqiang","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Orthopedics, General Hospital of Ningxia Medical University","place":["Yinchuan, Ningxia Hui Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Liu","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Ningxia Medical University","place":["Yinchuan, Ningxia Hui Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junxiao","family":"Liu","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Ningxia Medical University","place":["Yinchuan, Ningxia Hui Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanhua","family":"Guo","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Ningxia Medical University","place":["Yinchuan, Ningxia Hui Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhangui","family":"Gu","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Ningxia Medical University","place":["Yinchuan, Ningxia Hui Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long","family":"Ma","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Ningxia Medical University","place":["Yinchuan, Ningxia Hui Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ningkui","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Ningxia Medical University","place":["Yinchuan, Ningxia Hui Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiandang","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Ningxia Medical University","place":["Yinchuan, Ningxia Hui Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1177\/21925682251316814","article-title":"Streamlining the journey of research into clinical practice: Making your patients and practice flourish evaluation and treatment of pyogenic spondylodiscitis of the spine: AO spine knowledge forum trauma and infection","volume":"15","author":"Bigdon","year":"2025","journal-title":"Global Spine J."},{"key":"B2","doi-asserted-by":"publisher","first-page":"21925682251405776","DOI":"10.1177\/21925682251405776","article-title":"External validation of the SITE score for de novo spinal infections: A retrospective cohort study","volume":"16","author":"Britt","year":"2025","journal-title":"Global Spine J."},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.xnsj.2023.100293","article-title":"Surgical strategies for spinal infections: A narrative review","volume":"16","author":"Campbell","year":"2023","journal-title":"N. Am. Spine Soc J."},{"key":"B4","doi-asserted-by":"publisher","first-page":"3067","DOI":"10.1007\/s10096-025-05292-5","article-title":"Infectious spondylodiscitis: Epidemiology, diagnosis, microbiological findings, clinical features and outcomes in a 14-year retrospective study","volume":"44","author":"Conti","year":"2025","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms12050893","article-title":"Imaging of spondylodiscitis: A comprehensive updated review-multimodality imaging findings, differential diagnosis, and specific microorganisms detection","volume":"12","author":"Crombe","year":"2024","journal-title":"Microorganisms"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics13070671","article-title":"Microbiological profiles of patients with spondylodiscitis","volume":"13","author":"Froschen","year":"2024","journal-title":"Antibiotics (Basel)"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3390\/medicina61091591","article-title":"Pyogenic spondylodiscitis: Predictors of microbiological yield from biopsy in a tertiary hospital","volume":"61","author":"Haykir Solay","year":"2025","journal-title":"Med. (Kaunas)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.idc.2025.02.011","article-title":"Pyogenic vertebral osteomyelitis","volume":"39","author":"Henry","year":"2025","journal-title":"Infect. Dis. Clin. North. Am."},{"key":"B9","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s12879-023-08946-x","article-title":"The importance of the bacterial spectrum in the clinical diagnostics and management of patients with spontaneous pyogenic spondylodiscitis and isolated spinal epidural empyema: A 20-year cohort study at a single spine center","volume":"24","author":"Hijazi","year":"2024","journal-title":"BMC Infect. Dis."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11123356","article-title":"Recurrence rates and its associated factors after early spinal instrumentation for pyogenic spondylodiscitis: A nationwide cohort study of 2148 patients","volume":"11","author":"Lim","year":"2022","journal-title":"J. Clin. Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"23","DOI":"10.5194\/jbji-7-23-2022","article-title":"Diagnosis of vertebral osteomyelitis","volume":"7","author":"Maamari","year":"2022","journal-title":"J. Bone Jt Infect."},{"key":"B12","doi-asserted-by":"publisher","first-page":"3175","DOI":"10.1007\/s00586-023-08065-w","article-title":"Influence of instrumentation type on outcomes after surgical management of spondylodiscitis: A systematic review and meta-analysis","volume":"33","author":"Maddy","year":"2024","journal-title":"Eur. Spine J."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2024.107767","article-title":"Seasonal trends of pyogenic spondylodiscitis in Japan: A nationwide inpatient database study","volume":"153","author":"Motoyoshi","year":"2025","journal-title":"Int. J. Infect. Dis."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1227\/neu.0000000000003223","article-title":"Comparing conservative and early surgical treatments for pyogenic spondylodiskitis: An international propensity score-matched retrospective outcome analysis","volume":"96","author":"Neuhoff","year":"2025","journal-title":"Neurosurgery"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13092557","article-title":"Regional spondylodiscitis disparities: Impact on pathogen spectrum and patients","volume":"13","author":"Pantel","year":"2024","journal-title":"J. Clin. Med."},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines12112566","article-title":"Spondylodiscitis and its mimickers: A pictorial review","volume":"12","author":"Piccolo","year":"2024","journal-title":"Biomedicines"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14103477","article-title":"Evaluation and management of pyogenic spondylodiscitis: A review","volume":"14","author":"Placide","year":"2025","journal-title":"J. Clin. Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"396","DOI":"10.3171\/2022.11.spine22719","article-title":"A novel scoring system concept for de novo spinal infection treatment, the spinal infection treatment evaluation score (SITE score): A proof-of-concept study","volume":"38","author":"Pluemer","year":"2023","journal-title":"J. Neurosurg. Spine"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.5435\/jaaos-d-24-01088","article-title":"Management of pyogenic spondylodiscitis in adults","volume":"33","author":"Rawall","year":"2025","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"B20","doi-asserted-by":"publisher","first-page":"485","DOI":"10.22603\/ssrr.2024-0320","article-title":"Risk factors for delayed diagnosis of pyogenic spondylitis: A cross-sectional study with prospective case series","volume":"9","author":"Sato","year":"2025","journal-title":"Spine Surg. Relat. Res."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0287846","article-title":"Incidence and treatment trends of infectious spondylodiscitis in South Korea: A nationwide population-based study","volume":"18","author":"Son","year":"2023","journal-title":"PloS One"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.bas.2023.101733","article-title":"Increasing incidence of spondylodiscitis in England: An analysis of the national health service (NHS) hospital episode statistics from 2012 to 2021","volume":"3","author":"Thavarajasingam","year":"2023","journal-title":"Brain Spine"},{"key":"B23","doi-asserted-by":"publisher","first-page":"15647","DOI":"10.1038\/s41598-023-41381-1","article-title":"Conservative versus early surgical treatment in the management of pyogenic spondylodiscitis: A systematic review and meta-analysis","volume":"13","author":"Thavarajasingam","year":"2023","journal-title":"Sci. Rep."},{"key":"B24","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1016\/j.spinee.2023.09.018","article-title":"An international consensus based on the delphi method to define failure of medical treatment in pyogenic spinal infections","volume":"24","author":"Urrutia","year":"2024","journal-title":"Spine J."},{"key":"B25","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1186\/s13018-022-03269-0","article-title":"Posterior-only debridement, bone fusion, single-segment versus short-segment instrumentation for mono-segmental lumbar or lumbosacral pyogenic vertebral osteomyelitis: Minimum five year follow-up outcomes","volume":"17","author":"Zhang","year":"2022","journal-title":"J. Orthop. Surg. Res."},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.idcr.2024.e01930","article-title":"Is shigella an under-recognized pathogen? A case of pyogenic cervical spondylitis caused by escherichia coli and shigella flexneri infection","volume":"35","author":"Zhang","year":"2024","journal-title":"IDCases"}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1883513\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T12:52:22Z","timestamp":1787921542000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1883513\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":26,"alternative-id":["10.3389\/fcimb.2026.1883513"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1883513","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"article-number":"1883513"}}