Surgical Infections

Staphylococcus epidermidis, a commensal skin pathogen, is a key pathogen in surgical site infections (SSIs). This study characterized clinical isolates obtained from an abdominal operation to guide decolonization therapy.

In total, 146 S. epidermidis isolates obtained from pre-operative skin swabs of patients undergoing gynecological procedures were analyzed. PCR was performed to detect mecA, efflux pump genes (qacA/B, smr, etc.), and biofilm-associated genes (icaA-D, aap). Methicillin-resistant S. epidermidis (MRSE) isolates were typed by multi-locus sequence typing. Broth microdilution was used to assess susceptibility to benzalkonium chloride (BAC) and chlorhexidine digluconate (CHG). Biofilm formation was measured in the presence or absence of sub-inhibitory antiseptic exposure.

Of the isolates, 49.3% were MRSE, and 63.0% and 29.5% carried qacA/B and smr, respectively. MRSE showed higher minimum inhibitory concentration (MIC₅₀) values for both antiseptics. qac-positive strains exhibited significantly increased BAC MIC₅₀ (1 vs. 0.25 µg/mL; p < 0.001). Biofilm-forming isolates (16.4%) had three-fold higher BAC MIC₅₀ (p < 0.01). Sub-MIC exposure to BAC/CHG induced biofilm formation in prior non-producers (p < 0.05); among these, 81.3% were qac-positive, and 62.5% were MRSE.

The high prevalence of MRSE and efflux genes contributed to antiseptic tolerance. Sub-inhibitory antiseptic concentrations may enhance biofilm formation in resistant strains, underscoring the need for optimized decolonization tactics to prevent SSI.

Peristomal infection (PI) is the most frequent complication following percutaneous gastrostomy, and the increase of multi-drug-resistant (MDR) bacteria poses a therapeutic challenge. We evaluated whether targeted antimicrobial agent prophylaxis (TAP), on the basis of pre-procedure rectal screening, reduces the incidence of MDR PIs compared with standard prophylaxis.

We conducted a single-center, single-arm, open-label trial, comparing a prospective cohort (July 2021–July 2022) receiving TAP based on MDR screening results with a retrospective cohort (June 2020–June 2021) that received standard prophylaxis. A total of 118 patients were included, 60 in the intervention group and 58 in the historical cohort. TAP patients underwent a pre-procedure screening tactic, using nasal, axillary, inguinal, pharyngo-tonsillar, and rectal swabs. Patients with positive cultures received prophylaxis with an antibiotic agent active against the isolated bacteria, along with coverage for methicillin-sensitive Staphylococcus aureus. Patients with negative cultures received standard prophylaxis with amoxicillin–clavulanate. Both regimens were administered as a single dose one hour before the procedure.

MDR colonization was detected in 36.4% of screened patients. The 30-day PI incidence was comparable in both cohorts [20.7% (12/58) in the historical cohort vs. 16.7% (10/60) in the intervention group; p = 0.64]. Among TAP patients who developed PI, 7/10 had negative MDR screening, 3/10 had infections caused by pathogens different from those identified in screening, and 2/10 developed infections with the same MDR bacteria despite appropriate prophylaxis.

In patients undergoing percutaneous gastrostomy, TAP based on MDR colonization status did not reduce the incidence of PIs or MDR etiology compared with standard prophylaxis. Our findings question the role of colonization-guided prophylaxis in percutaneous gastrostomy and underscore the need for alternative preventive tactics in surgical site infection control.

Modified radical mastoidectomy (MRM) is a common surgical procedure in otology. However, postoperative surgical site infection (SSI) will lengthen hospital stay, raise healthcare expenses, and even lead to the death of patients. At present, there is relatively little research on the risk factors of SSI after MRM, especially the lack of an established risk prediction model.

Patients who underwent MRM at Jining NO.1 People’s Hospital from 2020 to 2024 were selected. Univariate analysis and multivariate logistic regression analysis were used to identify the risk factors for SSI after MRM. On the basis of these factors, a Nomogram prediction model was constructed. The predictive value of the model was evaluated by constructing receiver operating characteristic (ROC) curve, calibration curve, and decision curve.

A total of 278 MRM patients met the inclusion criteria, 19 (6.83%) had developed SSI, and 259 (93.17%) had not. Multivariate logistic regression analysis confirmed diabetes, hypoproteinemia, neutrophil-to-lymphocyte ratio, antibiotic prophylaxis administered 0.5–1 h preoperatively, and operative time as independent factors (all p <0.05). The prediction model demonstrated excellent discriminative ability. Area under the curve of the ROC curve was 0.856, validated by Hosmer–Lemeshow testing (χ² = 6.265, p = 0.618), calibration curve, and decision curve analysis. These findings highlight the model’s robust accuracy and clinical utility in stratifying the risk of SSI after MRM.

The Nomogram prediction model constructed based on logistic regression can effectively predict the risk of SSI after MRM, which is helpful for early clinical intervention and reducing the occurrence of nosocomial infection.

Necrotizing soft tissue infections (NSTIs) are life-threatening surgical emergencies characterized by rapid tissue destruction, systemic toxicity, and high mortality. Early recognition and aggressive treatment are critical.

A previously healthy 28-year-old male presented with one week of right shoulder and chest wall pain. Initially diagnosed with muscle strains via MRI, he re-presented to the emergency department five days later with hypotension. Blood cultures grew Streptococcus pyogenes, and imaging revealed extensive soft tissue involvement. Emergent fasciotomy and serial debridement revealed NSTI extending from the right shoulder to the scrotum and contralateral shoulder. Despite broad-spectrum antibiotics, debridements, continuous renal replacement therapy, and vasopressors, the patient developed multi-organ failure and died within 24 h of ICU admission.

This case highlights the aggressive nature of NSTIs, the importance of early diagnosis, a non-classical presentation, and the potential for rapid progression to multi-organ failure and death even in young, previously healthy individuals.

National trends toward earlier onset of diverticulitis combined with more advanced maternal age may converge, making diverticulitis an increasingly important etiology of obstetric abdominal infection. However, there is little data on this topic, and no specific guidelines on how to treat pregnant patients with the disease. The purpose of this study was to identify the frequency of hospitalization for diverticulitis in pregnant patients and the common complications associated with this disease process.

We conducted a retrospective cohort study using the National Readmissions Database (NRD) to evaluate maternal and fetal complications among pregnant patients diagnosed with diverticulitis. The NRD was queried for all visits in the first 3 quarters of each year, 2016–2019, that included a patient with an International Classification of Diseases-10 code for diverticulitis and pregnancy. These entries were then further investigated for demographics, gestational age, rates of intervention, readmissions, and maternal and fetal complications.

A total of 470 patients were identified with a diagnosis of diverticulitis and pregnancy. Most patients (n = 340, 72.3%) were in the third trimester of pregnancy at presentation. 160/470 (34.0%) of admissions led to fetal delivery within 48 h. Of these, 3.8% of patients (n = 18) had complicated diverticulitis on index admission. The 90-day readmission rate for perforation or abscess was 1.3%. There were no reported maternal deaths. The overall rate of maternal complications was 41.3% and fetal complications was 41%, including a 1.9% rate of fetal loss.

Diverticulitis is associated with significant rates of maternal and fetal complications when it occurs during pregnancy. Further investigation is warranted to better define the outcomes and guide best practices in this population.

Necrotizing pneumonia (NP) is a rare entity seen to occur in 0.9%–7% of cases of community-acquired pneumonia in the pediatric population. Medical management remains the cornerstone of treatment. However, the destruction of both parenchyma and blood vessels impairs blood flow, limiting antibiotic concentrations and allowing the infection to persist. Although surgical management remains debated, some authors advocate for it in cases of medical treatment failure or extensive disease. The objective of this study was to present the surgical outcomes of our experience in treating NP in the pediatric population.

A retrospective and observational study was conducted on all cases of NP in children who required surgical management between January 2022 and June 2024.

During the study period, a total of 142 pediatric thoracic surgeries were performed, of which 25 involved patients with NP, who were included in our analysis. The median age was 3 years (2–4), with a nearly equal gender distribution (52% female, n = 13). The median duration of symptoms prior to the surgical procedure was 27 days (22–36), antibiotic therapy duration ranged from 5 to 18 days. On the basis of computed tomography findings regarding the extent of parenchymal involvement, 17 patients underwent sublobar resections, while 8 required lobar resections. While no statistically significant differences were observed in post-operative outcomes between groups, it is noteworthy that patients who underwent lobectomy experienced a higher frequency of complications.

Surgical intervention, typically involving resection of necrotic lung tissue, may be considered in carefully selected pediatric patients who demonstrate persistent clinical deterioration despite optimized medical therapy and exhibit extensive parenchymal destruction on imaging. It is critical to tailor the treatment plan to the patient’s clinical status and disease progression.

Several studies have highlighted higher rates of adverse outcomes such as superficial surgical site infection (SSI) in Indigenous populations. However, there is a paucity of literature amalgamating reports of SSI in these populations compared with other ethnic and racial groups. The aim of this review is to highlight the incidence of SSI in Indigenous populations in the United States and Canada compared with non-Indigenous patients.

Based upon systematic assessment of relevant articles found in Scopus, PubMed, and PubMed Central, a state-of-the-art review was conducted. Studies in English that were cohort, cross-sectional, case–control, or randomized controlled studies on human beings of all ages and genders were included. Studies that were reviews, case series, case reports, editorials, letters to editors, animal studies, or studies that did not examine SSI as a direct outcome of surgical procedure were excluded.

We retrieved 1,718 articles, 9 of which were included for review. The most reported adverse surgical infection was superficial SSI. Five studies reported statistically significant increased risk of superficial SSI in Indigenous populations compared with White patients. Increased rates of deep incisional SSI for Indigenous populations compared with White patients were statistically significant in two of three studies looking at this outcome. As it relates to organ–space SSI, two studies reported statistically significant increases for Indigenous patients of the three studies reporting this parameter.

There are statistically significant differences in the incidence of SSI for Indigenous patients, particularly when compared with their White counterparts.

Surgical site infection (SSI) after pancreaticoduodenectomy (PD) remains a major cause of post-operative morbidity. Various risk factors for SSI have been identified. This study aimed to investigate the relationship between the C-reactive protein (CRP)–albumin–lymphocyte (CALLY) index, a novel inflammatory biomarker, and SSI following PD.

The outcomes of patients who underwent PD between January 2017 and December 2022 were retrospectively analyzed. Patients who underwent laparoscopic surgery, received neoadjuvant therapy for borderline or locally advanced tumors, had metastatic disease, or presented with evident infections requiring treatment at the time of surgery were excluded. Demographic data, post-operative outcomes, and the presence of SSI were recorded. The CALLY index and other potential risk factors for SSI were evaluated.

The cutoff value for the CALLY index was determined as 5. Patients with a CALLY index <5 had a significantly higher incidence of SSI (p < 0.001). Multi-variate analysis demonstrated risk factors for SSI included CALLY index, elevated pre-operative CRP level, post-operative pancreatic fistula, and pre-operative biliary drainage (p = 0.021, p = 0.003, p < 0.001, and p = 0.037, respectively). Multi-variate analysis demonstrated that the CALLY index was a strong independent predictor of SSI (odds ratio = 5.195; 95% confidence interval: 2.430–11.107).

The CALLY index is an independent risk factor for SSI after PD. This index reflects inflammation, immune status, and nutritional condition and represents a simple, non-invasive, and easily calculable predictive tool.

Liver transplantation is a life-saving procedure for patients with end-stage liver disease. Risk of post-transplantation infection remains high despite improvement in graft and patient survival. Antibacterial and antifungal prophylaxis plays an important role in reducing infection-related morbidity and mortality, but optimal timing and regimens are not well defined.

The Surgical Infection Society’s (SIS) Therapeutics and Guidelines Committee and individuals with content expertise convened to develop guidelines on antibacterial and antifungal prophylaxis in liver transplant to prevent surgical site infection and other infections, shorten intensive care unit length of stay, and decrease mortality. PubMed, Embase, Web of Science, and the Cochrane Database were searched using Medical Subject Heading terms including “liver transplantation,” “antibiotic prophylaxis,” and “antifungal prophylaxis” for studies limited to randomized controlled trials, systematic reviews, meta-analyses, cohort, and case–control studies in adult patients. Evaluation of the published evidence was performed using the Grading of Recommendations Assessment, Development and Evaluation system, and final recommendations were developed by an iterative process.

We cannot make a recommendation for or against using pre-operative (more than 1 h before incision) antibiotic agent prophylaxis in liver transplantation with available evidence. We suggest the use of broad-spectrum antibiotic agent prophylaxis in liver transplantation rather than gram-positive antibiotic agent prophylaxis alone (Grade 2B). We recommend limiting administration of antibiotic agent prophylaxis to 24 hours post-operatively after liver transplant (Grade 1B). We recommend against empiric antifungal prophylaxis for patients at low risk for invasive fungal infections (IFIs) after liver transplant; for patients at high risk for IFI, we recommend antifungal prophylaxis (Grade 1B).

This guideline summarizes the current SIS recommendations on antibacterial and antifungal prophylaxis in liver transplantation.

Debridement, antibiotics, and implant retention (DAIR) is a commonly used tactic for the management of acute periprosthetic joint infection (PJI) following total hip arthroplasty. However, patient selection remains challenging, and predictors of treatment failure are not clearly defined.

A retrospective cohort study was conducted in a single center including 48 patients treated with DAIR for acute hip PJI between 2000 and 2019. Clinical characteristics, comorbidities, microbiological findings, and perioperative variables were analyzed. Treatment failure was defined as the need for implant removal or exchange, resection arthroplasty, or chronic suppressive antibiotic therapy. Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to explore factors associated with DAIR failure.

The mean age was 69.3 years. At a mean follow-up of 23.7 months, infection control was achieved in 83.3% of cases. Polymicrobial infection was significantly associated with treatment failure compared with monomicrobial infection (57.1% vs. 87.5%, p = 0.049). An exploratory predictive model demonstrated acceptable to good discriminatory performance in this exploratory cohort for DAIR outcome (area under the curve = 0.87).

DAIR is an effective treatment option for selected patients with acute hip PJI. Polymicrobial infection was associated with treatment failure and should prompt careful consideration of alternative surgical strategies. Exploratory risk stratification models may assist in preoperative decision-making; however, validation in larger cohorts is required.

This retrospective analysis investigated the role of serum IL-6 and IL-10 in distinguishing among pathological types of acute appendicitis and in preoperatively predicting perforation.

The data from 376 patients were categorized into three groups on the basis of the definitive postoperative histopathological diagnosis: acute simple appendicitis (SIA), acute suppurative appendicitis (SA), and acute gangrenous appendicitis (GA). According to whether acute appendicitis is accompanied by perforation, the subjects are further stratified into two groups: non-perforated and perforated.

A statistically significant difference in IL-6 levels was observed among the groups (SIA vs. SA, p < 0.0001; SIA vs. GA, p < 0.0001; SA vs. GA, p < 0.0001). The IL-6 independently predicted a types of appendicitis pathology [SIA vs. SA: odds ratio (OR) 1.059, 95% confidence interval (CI) (1.039–1.079), p < 0.0001; SIA vs. GA: OR 1.080, 95% confidence interval (CI) (1.049–1.113), p < 0.0001; SA vs. GA: OR 1.000, 95% confidence interval (CI) (1.000–1.000), p = 0.05]. The optimum cut-off for the initial IL-6 was 23.54 [area under the curve (AUC) 0.8512, SIA vs. SA)], 39.36 (AUC 0.9844, SIA vs. GA), and 90.88 (AUC 0.8433, SA vs. GA). The IL-6 was significantly higher in the perforated group than in the non-perforated group (29.86 vs. 453.50, p < 0.001). The IL-6 independently predicted acute perforated appendicitis in multi-variable logistic regression analysis [OR 1.000, 95% confidence interval (CI) (1.000–1.000), p < 0.042]. The optimum cut-off for acute perforated appendicitis was 331.3 (AUC 0.8074). The diagnostic performance of IL-10 in differentiating acute appendicitis pathology types was fair (AUC 0.7322 for SIA vs. SA; 0.92263 for SIA vs. GA; 0.7738 for SA vs. GA) but consistently lower than IL-6, and its predictive value for acute perforated appendicitis remained limited (AUC 0.7875), further underscoring the superior discriminative capacity of IL-6.

Preoperative evaluation of IL-6 and IL-10 can be useful in distinguishing pathological subtypes of acute appendicitis and predicting associated perforation.

Complicated appendicitis remains a leading cause of post-operative morbidity in children, but the relationship between specific microbial resistance profiles and clinical outcomes is poorly defined.

We conducted a retrospective cohort study of pediatric patients (<18 y) who underwent appendectomy for complicated appendicitis at a tertiary children’s hospital (2019–2024). Demographic, operative, and outcome data were abstracted from the National Surgical Quality Improvement Program Pediatric database and electronic health records. Intra-operative cultures were analyzed for bacterial species, gram stain morphology, and antibiotic agent resistance. Hierarchical clustering of weighted resistance scores identified resistance-based microbial groupings. The primary outcome was post-operative organ–space infection (OSI), and secondary outcomes included length of stay (LOS) and 30-day re-admission.

Among 194 children (median age = 10.2 y; 56.2% male), 26 (13.4%) developed OSI. Culture analysis (n = 176 with samples) demonstrated that polymicrobial infections with ≥3 bacterial species isolated and the presence of Bacteroides fragilis increased the odds of OSI by 3.04× (95% confidence interval [CI] = 1.18–7.80, p = 0.010) and 2.40× (95% CI = 1.01–5.35; p = 0.021), respectively. Cluster analysis revealed three groups reflecting resistance burden and clinical phenotype. The Enterobacteriaceae group and a hard-to-treat cluster were associated with longer hospital stays (both p < 0.02), and the hard-to-treat cluster with increased 30-day re-admissions (5.6% vs. 1.5%; p = 0.040).

Children with OSI exhibited distinct microbiologic features, including polymicrobial cultures and B. fragilis. Resistance-weighted clusters were linked to longer LOS and re-admission, highlighting that intra-operative cultures, traditionally considered low yield, may provide prognostic information with implications for post-operative management and antibiotic agent stewardship in pediatric complicated appendicitis.

Pyelonephritis is quite common in patients with urolithiasis. This condition not only complicates the management of urolithiasis but also makes the treatment of associated urinary tract infections more challenging. The aim of this study is to identify the risk factors for pyelonephritis in patients with urolithiasis.

A total of 8,273 patients with urolithiasis were retrospectively screened (2016–2025). From this cohort, 302 patients who developed pyelonephritis and 302 age- and gender-matched controls without pyelonephritis were randomly selected, forming a matched case–control study population. Demographic and clinical variables, including age, gender, stone size and location, number of stones, comorbidities, prior urinary operation, presence of a double-J ureteral stent, and urinary tract obstruction, were analyzed as potential risk factors.

Pyelonephritis developed in 302 patients (53.3% female). Hydronephrosis was the strongest independent risk factor, increasing risk nearly ninefold. Other significant risk factors included hypertension, diabetes mellitus, chronic kidney disease, malignant disease, immunosuppression, larger stone burden, multiple and bilateral stones, ureteral stent presence, and prior urinary operation. Each 1-mm increase in stone size was associated with a 2.3% increase in the risk of developing pyelonephritis. Bacteremia was detected in 66 patients, and urine cultures were positive in 229 patients. Escherichia coli was the most common pathogen, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa.

Hydronephrosis, ureteral stent presence, a history of open or laparoscopic intervention, hypertension, and higher stone burden were independently associated with the development of pyelonephritis in patients with urolithiasis. Gram-negative bacilli were the most frequently isolated pathogens. Identification of these risk factors may support earlier recognition of high-risk patients and guide preventive and therapeutic decision-making. Prospective multi-center studies are needed to confirm these findings.

Postoperative abdominopelvic abscesses are primarily managed with antimicrobial therapy and percutaneous drainage. A subset of abscesses is unamenable to drainage due to small size or technical inaccessibility and is therefore managed conservatively with antimicrobial therapy alone. Clinical outcomes and factors of treatment failure with antimicrobial therapy alone for postoperative non-drainable abscesses remain poorly defined.

A retrospective cohort study included adult surgical patients at a tertiary hospital with abdominopelvic abscesses diagnosed within 30 days postoperatively and deemed non-drainable. All patients received systemic antimicrobials and were followed for 60 days. The primary outcome was therapy success. Other outcomes included clinical response, rehospitalization, and exploration of risk factors for antimicrobial therapy failure.

The study included 69 patients. Abscesses were considered non-drainable because of inaccessible location (n = 47, 68.1%) or small size (n = 22, 31.9%). The median duration of antimicrobial therapy was 18 days, including 12 days of inpatient treatment. At 60 days from antimicrobials initiation, 53 patients (76.8%) achieved therapy success. The median time to clinical response was 8 days. Among patients with follow-up imaging, most demonstrated abscess resolution or reduction in size. Independent predictors of treatment failure were pelvic abscess location (odds ratio [OR], 6.8; 95% confidence interval [CI], 1.5–30.3) and postoperative corticosteroid exposure (OR, 11.9; 95% CI: 1.1–129.7). A longer interval between procedure and abscess diagnosis was inversely associated with failure (OR, 0.8 per day; 95% CI, 0.7–0.9).

When postoperative abdominopelvic abscesses are deemed not amenable to drainage, antimicrobial therapy with close clinical follow-up was associated with favorable outcomes.

Surgical Care Improvement Project (SCIP) recommends prophylactic antibiotic agents (abx) within 60 min before incision. This quality improvement study assessed SCIP compliance in emergent cesarean sections (CSs) to identify opportunities for improvement.

This retrospective study included patients undergoing emergent CSs at our institution between May 2016 and December 2023. Maternal demographic, obstetric, medical, and labor outcomes were abstracted. The primary outcome was the incidence of timely (within 60 min of incision) administration of abx. Secondary outcomes included maternal intensive care unit (ICU) admission, hospital length of stay (LOS), loss to follow-up, surgical site infection (SSI), and 30-day outcomes. Logistic regression analyses were performed to identify predictors of SCIP compliance.

A total of 876 patients were included in the study. The most common indication for CSs was non-reassuring fetal status, and the most common form of anesthesia was epidural. Abx were administered in 98% of cases, but only 73% were SCIP compliant. Chlorhexidine-alcohol was most commonly used for abdominal skin preparation. There were significant differences between the SCIP Not Compliant versus Compliant group, but multiple logistic regression identified only American Society of Anesthesiologists (ASA) Class 3 (OR: 0.69 95% CI: 0.49–0.97, p = 0.034), ASA Classes 4/5 (OR: 0.22 95% CI: 0.04–0.96, p = 0.047), and prolapsed cord as indication for CSs (OR: 0.22 95% CI: 0.10–0.49, p < 0.001) as predictors of SCIP Not Compliant. Maternal morbidity was low, with only 2% ICU admission and median hospital LOS 4 days. Only (5%) were lost to follow-up. SSI rate was low (4%).

We identified timeliness of pre-operative abx administration, abdominal skin preparation agent, and post-discharge follow-up as opportunities for improvement. SCIP non-compliance was significantly associated with emergent cesarean indication and higher ASA class. Post-operative SSI rates were low, though bias may be present because of the high loss-to-follow-up.

Thrombocytopenia is one of the common serious complications among complicated intra-abdominal infection (cIAI) patients. Maximum amplitude (MA), a thromboelastography parameter, represents fibrinogen levels, platelet count, and platelet function. Our study aimed to elucidate the association between decreased MA and mortality among cIAI patients with thrombocytopenia.

cIAI patients with thrombocytopenia were enrolled-in. Clinical data and various laboratory values were collected. Uni-variable analysis and multi-variable logistic regression were used to evaluate the correlation between decreased MA and mortality. The area under the curve (AUC) was calculated to evaluate the predictive performance.

A total of 58 cIAI patients with thrombocytopenia were included. According to the uni-variable analysis, decreased MA was significantly associated with patient mortality (odds ratio [OR]: 15.41, 95% confidence interval [CI]: 4.03–58.91; p < 0.001). In the multi-variable analysis model 1, which was adjusted for age and gender, decreased MA remained significantly associated with increased patient mortality (OR: 10.96, 95% CI: 2.44–49.20; p = 0.002). After adjusting for age, gender, platelet count, acute physiology and chronic health evaluation II score, and sequential organ failure assessment score (model 2), decreased MA was also a risk factor for patient mortality (OR: 12.66, 95% CI: 1.81–88.78; p = 0.011). MA levels were significantly lower in non-survivors than in survivors (all p < 0.05). The AUC of MA for predicting mortality was 0.72 (95% CI: 0.58–0.87; p = 0.0036).

Decreased MA may be a potential parameter to help predict the likelihood of mortality in cIAI patients with thrombocytopenia.

Differentiating spinal tuberculosis (STB) from pyogenic spinal infection (PSI) remains a critical diagnostic challenge, and misdiagnosis can lead to inappropriate treatment, prolonged morbidity, and poor clinical outcome.

This study aims to develop a convenient, practical model on the basis of routinely available clinical data to accurately differentiate between STB and PSI.

We retrospectively reviewed 211 patients (59 STB, 152 PSI) with pathological confirmation in our hospital’s orthopedic department, collecting general data (age, gender, BMI, tuberculosis history), laboratory indices (T-SPOT.TB, white blood cell, NP, C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], hemoglobin, etc.), and imaging findings (intervertebral disc destruction [IDD], vertebral body destruction [VBD], sclerotic bone and sequestrum formation [SBSF], intraspinal abscess [ITA], injection abscess). Univariate and multivariate regressions identified independent factors to construct a nomogram, whose performance was assessed via receiver operating characteristic curves, calibration curves, and decision curve analysis.

Univariate analysis revealed that the T-SPOT.TB, CRP, ESR, albumin, albumin-to-globulin ratio, IDD, VBD, SBSF, and ITA were statistically significant. Multifactorial logistic regression analysis revealed that the T-SPOT. TB, CRP, ESR, and albumin were strongly associated with STB. The nomogram model was established via R software on the basis of risk factors. The area under the receiver operating characteristic of the subjects in the modeling group was 0.770. According to the nomogram model, the predicted value of the calibration curve was consistent with the actual value. Conclusion: This nomogram provides a reliable, simple, economical, practical tool for differentiating STB from PSI. By enabling accurate and timely distinction between these two infectious entities, the model facilitates the development of targeted and more effective treatment strategies.