{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:32:56Z","timestamp":1760236376508,"version":"build-2065373602"},"reference-count":36,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T00:00:00Z","timestamp":1637020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: In patients under immunosuppression or severe sepsis, it is sometimes manifested as coexisting septic arthritis and spondylitis. The aim of this study is to evaluate and investigate the risk factors of infectious spondylitis associated with septic arthritis. Methods: The study retrospectively reviewed the patients diagnosed with infectious spondylitis between January 2010 and September 2018 for risk factors of coexisting major joint septic arthritis. Results: A total of 10 patients with infectious spondylitis and coexisting septic arthritis comprised the study group. Fifty matched patients with solely infectious spondylitis were selected as the control group. Major risk factors include preoperative C-reactive protein (p = 0.001), hypoalbuminemia (p = 0.011), history of total joint replacement (p &lt; 0.001), duration of preoperative antibiotics treatment (p = 0.038) and psoas muscle abscess (p &lt; 0.001). Conclusion: Infectious spondylitis and septic arthritis are thought of as medical emergencies due to their high mortality and morbidity. Our study evaluated 5 risk factors as significant major findings: hypoalbuminemia (&lt;3.4 g\/dL), higher preoperative CRP (&gt;130 mg\/L), psoas muscle abscess, longer preoperative antibiotics treatment (&gt;8 days) and history of total joint replacement. Clinicians should pay attention to the patients with those five factors to detect the coexisting infections as early as possible.<\/jats:p>","DOI":"10.3390\/jcm10225345","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T02:42:28Z","timestamp":1637116948000},"page":"5345","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Risk Factors of Coexisting Septic Spondylitis and Arthritis: A Case-Control Study in a Tertiary Referral Hospital"],"prefix":"10.3390","volume":"10","author":[{"given":"Sheng-Fen","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2020-919X","authenticated-orcid":false,"given":"Po-Liang","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsiang-Fu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7776-7627","authenticated-orcid":false,"given":"Tsung-Ting","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Chih","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun-Da","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ping-Yeh","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-Kai","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fu-Cheng","family":"Kao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.idc.2017.01.003","article-title":"Infections of the Spine","volume":"31","author":"Babic","year":"2017","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_2","first-page":"91","article-title":"Extension of lumbar spine infection into osteoarthritic hip through psoas abscess","volume":"10","author":"Kumagai","year":"2005","journal-title":"J. Orthop. Sci. Off. J. Jpn. Orthop. Assoc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1302\/0301-620X.87B11.16294","article-title":"Spinal infections","volume":"87","author":"Govender","year":"2005","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.1097\/00007632-200007010-00010","article-title":"Hematogenous pyogenic spinal infections and their surgical management","volume":"25","author":"Hadjipavlou","year":"2000","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"E106","DOI":"10.1097\/01.BRS.0000050402.11769.09","article-title":"Psoas abscess: The spine as a primary source of infection","volume":"28","author":"Kirschner","year":"2003","journal-title":"Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1097\/00007632-200107150-00014","article-title":"Hematogenous pyogenic facet joint infection","volume":"26","author":"Muffoletto","year":"2001","journal-title":"Spine"},{"key":"ref_7","first-page":"226","article-title":"Vertebral osteomyelitis","volume":"26","author":"Hadjipavlou","year":"2000","journal-title":"Curr. Treat. Options Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.idc.2017.01.001","article-title":"Septic Arthritis of Native Joints","volume":"31","author":"Ross","year":"2017","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1056\/NEJM198503213121206","article-title":"Bacterial arthritis","volume":"312","author":"Goldenberg","year":"1985","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1128\/CMR.15.4.527-544.2002","article-title":"Acute septic arthritis","volume":"15","author":"Shirtliff","year":"2002","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/S0140-6736(09)61595-6","article-title":"Bacterial septic arthritis in adults","volume":"375","author":"Mathews","year":"2010","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1136\/ard.56.8.470","article-title":"Incidence and sources of native and prosthetic joint infection: A community based prospective survey","volume":"56","author":"Kaandorp","year":"2010","journal-title":"Ann. Rheum. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1136\/ard.61.3.267","article-title":"No changes in the distribution of organisms responsible for septic arthritis over a 20 year period","volume":"61","author":"Dubost","year":"2002","journal-title":"Ann. Rheum. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.berh.2011.02.001","article-title":"Septic arthritis","volume":"25","author":"Balsa","year":"2011","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1177\/000313481708301123","article-title":"Hypoalbuminemia and Clinical Outcomes: What is the Mechanism behind the Relationship?","volume":"83","author":"Kim","year":"2017","journal-title":"Am. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"189","DOI":"10.3109\/0886022X.2011.646885","article-title":"Association of hypoalbuminemia with severe anemia in patients with diabetic nephrosclerosis","volume":"34","author":"Sasatomi","year":"2012","journal-title":"Ren. Fail."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"754","DOI":"10.3389\/fimmu.2018.00754","article-title":"Role of C-Reactive Protein at Sites of Inflammation and Infection","volume":"9","author":"Sproston","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1038\/s41372-019-0363-4","article-title":"Procalcitonin versus C-reactive protein: Review of kinetics and performance for diagnosis of neonatal sepsis","volume":"39","author":"Eschborn","year":"2019","journal-title":"J. Perinatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1111\/j.1469-0691.2012.04002.x","article-title":"Influence of material on the development of device-associated infections","volume":"18","author":"Rochford","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ijscr.2017.11.054","article-title":"Psoas abscess masquerading as a prosthetic hip infection: A case report","volume":"42","author":"Atif","year":"2018","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1111\/j.0894-0959.2004.17603.x","article-title":"Poor nutritional status and inflammation: Serum Albumin: Relationship to Inflammation and Nutrition","volume":"17","author":"Don","year":"2004","journal-title":"Semin. Dial."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S193","DOI":"10.1007\/s11739-012-0802-0","article-title":"Hypoalbuminemia","volume":"7","author":"Gatta","year":"2012","journal-title":"Intern. Emerg. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/jpen.1451","article-title":"Hypoalbuminemia: Pathogenesis and Clinical Significance","volume":"43","author":"Soeters","year":"2019","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Wiedermann, C.J. (2021). Hypoalbuminemia as Surrogate and Culprit of Infections. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22094496"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1046\/j.1365-2044.1998.00438.x","article-title":"Serum albumin: Touchstone or totem?","volume":"53","author":"Margarson","year":"1998","journal-title":"Anaesthesia"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1177\/014860718000400404","article-title":"Incidence and mortality of hypoalbuminemic patients in hospitalized veterans","volume":"4","author":"Reinhardt","year":"1980","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1097\/MAJ.0000000000000350","article-title":"Predictive factors for metastatic infection in patients with bacteremia caused by methicillin-sensitive Staphylococcus aureus","volume":"349","author":"Horino","year":"2015","journal-title":"Am. J. Med. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.jinf.2003.10.010","article-title":"Positive surveillance blood culture is a predictive factor for secondary metastatic infection in patients with Staphylococcus aureus bacteraemia","volume":"48","author":"Lesens","year":"2004","journal-title":"J. Infect."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Botheras, C.L., Bowe, S.J., Cowan, R., and Athan, E. (2021). C-reactive protein predicts complications in community-associated S. aureus bacteraemia: A cohort study. BMC Infect. Dis. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-05962-7"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Tsai, T.-T., Yang, S.-C., Niu, C.-C., Lai, P.-L., Lee, M.-H., Chen, L.-H., and Chen, W.-J. (2017). Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: A retrospective cohort study. BMC Musculoskelet. Disord., 18.","DOI":"10.1186\/s12891-017-1533-1"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/SLE.0b013e31826e0ac9","article-title":"Iliopsoas abscess: Presentation, management, and outcomes","volume":"23","author":"Dietrich","year":"2013","journal-title":"Surg. Laparosc. Endosc. Percutaneous Tech."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1097\/MD.0b013e31819d2748","article-title":"Microbiology and outcome of iliopsoas abscess in 124 patients","volume":"88","author":"Ramos","year":"2009","journal-title":"Medicine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1097\/00007611-199508000-00017","article-title":"Primary psoas abscess due to methicillin-resistant Staphylococcus aureus concurrent with septic arthritis of the hip joint","volume":"88","author":"Ash","year":"1995","journal-title":"South. Med. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1101\/gad.1645008","article-title":"Control of cell fate by the formation of an architecturally complex bacterial community","volume":"22","author":"Vlamakis","year":"2008","journal-title":"Genes Dev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/S0140-6736(01)05321-1","article-title":"Antibiotic resistance of bacteria in biofilms","volume":"358","author":"Stewart","year":"2001","journal-title":"Lancet"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1056\/NEJMra040181","article-title":"Prosthetic-joint infections","volume":"351","author":"Zimmerli","year":"2004","journal-title":"N. Engl. J. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/22\/5345\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:31:21Z","timestamp":1760167881000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/22\/5345"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,16]]},"references-count":36,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["jcm10225345"],"URL":"https:\/\/doi.org\/10.3390\/jcm10225345","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2021,11,16]]}}}