Atopic Dermatitis as a Prognostic Factor in Younger Patients with Pyogenic Spondylitis

ObjectivePyogenic spondylitis is becoming more common due to population aging and increases in treatment-related bacterial infection. Additionally, improved access to magnetic resonance imaging has led to the identification of more cases of pyogenic spondylitis. However, pyogenic spondylitis can also occur in relatively young people. In this study, we compared background factors and the course of treatment between younger and older patients. MethodsA retrospective review of our hospital database identified 35 consecutive cases of pyogenic spondylitis treated between 2019 and 2024. After eight exclusions, 27 patients were selected. Outcomes were compared between patients younger than 65 years (n=9) and those aged 65 years or older (n=18). ResultsThere was no significant difference in sex, site of the lesion, or presence or absence of a causative bacterium according to age group. Atopic dermatitis was significantly more common in younger patients (n=5, 56% vs. n=0, 0%, p=0.007), while diabetes mellitus or prior bacterial infection was less common (n=3, 33% vs. n=16, 83%, p=0.003). Surgery was more common in younger patients (n=5, 56% vs n=6, 33%), as was discharge to home (n=8, 89% vs. n=6, 33%, p=0.01). ConclusionsDiabetes mellitus and prior bacterial infection, which are known risk factors for pyogenic spondylitis, were less common in younger patients. Furthermore, atopic dermatitis was more common in younger patients. Owing to the breakdown of the skin barrier, atopic dermatitis is known to cause not only skin-limited infections but also bacteremia-associated conditions such as infective endocarditis and pyogenic arthritis. Our finding that younger patients are more likely to be discharged home highlights the importance of appropriate treatment.