1887

Abstract

Purpose. Spondylodiscitis as a rare disease has increased in recent years; there are only a few recommendations regarding the diagnostics and treatment. The objective of this retrospective study was to characterise these patients and identify factors for a favourable healing process – with an emphasis on antibiotic therapy.

Methodology. Findings/treatment regimens for all patients with spondylodiscitis treated at a tertiary care hospital in 2012/2013 were recorded. The patients were classified into two groups, depending on the healing process.

Results. Fifty-seven patients met the clinical/radiological criteria for spondylodiscitis. The main symptom was massive back pain, combined with a moderate CRP elevation (median 96 mg l), and occasionally fever (39 %). CT-guided aspiration – in addition to blood cultures – improved the detection rate for the causative pathogen from 49 to 82 %. Thirty patients had a favourable clinical course; 25 had an unfavourable clinical course (prolonged clinical course, recurrence, death). Pathogen-specific antibiotic therapy had a decisive effect on the clinical course: initial high-dose intravenous therapy for at least 14 days was associated significantly more often with a favourable clinical course (90 vs 30 % after 24 months, P<0.001). Fourteen days after the start of treatment, marked pain reduction and a CRP reduction of at least 50 % were good prognostic parameters and markers of effective antibiotic therapy.

Conclusion. Pathogen detection and establishment of an optimal antibiotic regimen are cornerstones of successful conservative therapy for spondylodiscitis. Targeted initial intravenous therapy for at least 14 days with a bactericidal antibiotic leads to a better clinical course.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000703
2018-04-23
2019-10-20
Loading full text...

Full text loading...

/deliver/fulltext/jmm/67/6/757.html?itemId=/content/journal/jmm/10.1099/jmm.0.000703&mimeType=html&fmt=ahah

References

  1. Grammatico L, Baron S, Rusch E, Lepage B, Surer N et al. Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002–2003. Epidemiol Infect 2008; 136: 653– 660 [CrossRef] [PubMed]
    [Google Scholar]
  2. Bettini N, Girardo M, Dema E, Cervellati S. Evaluation of conservative treatment of non specific spondylodiscitis. Eur Spine J 2009; 18: 143– 150 [CrossRef] [PubMed]
    [Google Scholar]
  3. Kehrer M, Pedersen C, Jensen TG, Lassen AT. Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. J Infect 2014; 68: 313– 320 [CrossRef] [PubMed]
    [Google Scholar]
  4. Jensen AG, Espersen F, Skinhøj P, Rosdahl VT, Frimodt-Møller N et al. Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980-1990. J Infect 1997; 34: 113– 118 [CrossRef] [PubMed]
    [Google Scholar]
  5. Spilf Primary infectious spondylitis, and following intradiscal procedure, without prothesis. Recommendations. Med Mal Infect 2007; 37: 573– 583 [PubMed] [Crossref]
    [Google Scholar]
  6. Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF et al. 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis 2015; 61: e26 e46 [CrossRef] [PubMed]
    [Google Scholar]
  7. Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 2010; 65: iii11– iii24 [CrossRef] [PubMed]
    [Google Scholar]
  8. Zarrouk V, Feydy A, Sallès F, Dufour V, Guigui P et al. Imaging does not predict the clinical outcome of bacterial vertebral osteomyelitis. Rheumatology 2007; 46: 292– 295 [CrossRef] [PubMed]
    [Google Scholar]
  9. Yoon SH, Chung SK, Kim KJ, Kim HJ, Jin YJ et al. Pyogenic vertebral osteomyelitis: identification of microorganism and laboratory markers used to predict clinical outcome. Eur Spine J 2010; 19: 575– 582 [CrossRef] [PubMed]
    [Google Scholar]
  10. Modic MT, Feiglin DH, Piraino DW, Boumphrey F, Weinstein MA et al. Vertebral osteomyelitis: assessment using MR. Radiology 1985; 157: 157– 166 [CrossRef] [PubMed]
    [Google Scholar]
  11. Leone A, dell'atti C, Magarelli N, Colelli P, Balanika A et al. Imaging of spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 16: 8– 19 [PubMed]
    [Google Scholar]
  12. Podbielski A, Abele-Horn M, Bücker A et al. Mikrobiologische Diagnostik der Arthritis und Osteomyelitis. In Podbielski A, Abele-Horn M, Herrmann M. (editors) Mikrobiologisch-Infektologische Qualitätsstandards (MIQ 18) Urban & Fischer; 2014; pp. 44– 64
    [Google Scholar]
  13. Legrand E, Flipo RM, Guggenbuhl P, Masson C, Maillefert JF et al. Management of nontuberculous infectious discitis. treatments used in 110 patients admitted to 12 teaching hospitals in France. Joint Bone Spine 2001; 68: 504– 509 [CrossRef] [PubMed]
    [Google Scholar]
  14. Pigrau C, Almirante B, Flores X, Falco V, Rodríguez D et al. Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome. Am J Med 2005; 118: 1287.e17– 1281287 [CrossRef] [PubMed]
    [Google Scholar]
  15. Kowalski TJ, Berbari EF, Huddleston PM, Steckelberg JM, Osmon DR et al. Do follow-up imaging examinations provide useful prognostic information in patients with spine infection?. Clin Infect Dis 2006; 43: 172– 179 [CrossRef] [PubMed]
    [Google Scholar]
  16. Roblot F, Besnier JM, Juhel L, Vidal C, Ragot S et al. Optimal duration of antibiotic therapy in vertebral osteomyelitis. Semin Arthritis Rheum 2007; 36: 269– 277 [CrossRef] [PubMed]
    [Google Scholar]
  17. Hopkinson N, Patel K. Clinical features of septic discitis in the UK: a retrospective case ascertainment study and review of management recommendations. Rheumatol Int 2016; 36: 1319– 1326 [CrossRef] [PubMed]
    [Google Scholar]
  18. Park KH, Chong YP, Kim SH, Lee SO, Choi SH et al. Clinical characteristics and therapeutic outcomes of hematogenous vertebral osteomyelitis caused by methicillin-resistant Staphylococcus aureus. J Infect 2013; 67: 556– 564 [CrossRef] [PubMed]
    [Google Scholar]
  19. Soehle M, Wallenfang T. Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes. Neurosurgery 2002; 51: 79– 87 Discussion 86-7 [CrossRef] [PubMed]
    [Google Scholar]
  20. Carragee EJ. Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 1997; 79: 874– 880 [CrossRef] [PubMed]
    [Google Scholar]
  21. McHenry MC, Easley KA, Locker GA. Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 2002; 34: 1342– 1350 [CrossRef] [PubMed]
    [Google Scholar]
  22. D'Agostino C, Scorzolini L, Massetti AP, Carnevalini M, D'Ettorre G et al. A seven-year prospective study on spondylodiscitis: epidemiological and microbiological features. Infection 2010; 38: 102– 107 [CrossRef] [PubMed]
    [Google Scholar]
  23. Casser HR, Seddigh S, Rauschmann M. Acute lumbar back pain—investigation, differential diagnosis and treatment. Dtsch Arztebl Int 2016; 113: 563– 564
    [Google Scholar]
  24. Nationale VersorgungsLeitlinie Nicht-spezifischer Kreuzschmerz. Langfassung 2. Auflage, 2017 Version 1; AWMF-Register:Nr.: nvl-007. www.awmf.org/uploads/tx_szleitlinien/nvl-007l_S3_Kreuzschmerz_2017-03.pdf
  25. Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001; 344: 363– 370 [CrossRef] [PubMed]
    [Google Scholar]
  26. Sobottke R, Seifert H, Fätkenhäuer G et al. Aktuelle Diagnostik und Therapie der Spondylodiszitis. Dtsch Ärzteblatt 2008; 105: 181– 187
    [Google Scholar]
  27. Nolla JM, Ariza J, Gómez-Vaquero C, Fiter J, Bermejo J et al. Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum 2002; 31: 271– 278 [CrossRef] [PubMed]
    [Google Scholar]
  28. Jung N, Seifert H, Siewe J, Fätkenheuer G. [Vertebral osteomyelitis]. Internist 2013; 54: 945– 953 [CrossRef] [PubMed]
    [Google Scholar]
  29. Gupta A, Kowalski TJ, Osmon DR, Enzler M, Steckelberg JM et al. Long-term outcome of pyogenic vertebral osteomyelitis: a cohort study of 260 patients. Open Forum Infect Dis 2014; 1: ofu107 [CrossRef] [PubMed]
    [Google Scholar]
  30. Yilmaz U. [Spondylodiscitis]. Radiologe 2011; 51: 772– 778 [CrossRef] [PubMed]
    [Google Scholar]
  31. Varma R, Lander P, Assaf A. Imaging of pyogenic infectious spondylodiskitis. Radiol Clin North Am 2001; 39: 203– 213 [CrossRef] [PubMed]
    [Google Scholar]
  32. Tins BJ, Cassar-Pullicino VN. MR imaging of spinal infection. Semin Musculoskelet Radiol 2004; 8: 215– 229 [CrossRef] [PubMed]
    [Google Scholar]
  33. Grados F, Lescure FX, Senneville E, Flipo RM, Schmit JL et al. Suggestions for managing pyogenic (non-tuberculous) discitis in adults. Joint Bone Spine 2007; 74: 133– 139 [CrossRef] [PubMed]
    [Google Scholar]
  34. Cottle L, Riordan T. Infectious spondylodiscitis. J Infect 2008; 56: 401– 412 [CrossRef] [PubMed]
    [Google Scholar]
  35. Zimmerli W. Vertebral Osteomyelitis. N Engl J Med Overseas Ed 2010; 362: 1022– 1029 [CrossRef]
    [Google Scholar]
  36. Desoutter S, Cottier JP, Ghout I, Issartel B, Dinh A et al. Susceptibility pattern of microorganisms isolated by percutaneous needle biopsy in nonbacteremic pyogenic vertebral osteomyelitis. Antimicrob Agents Chemother 2015; 59: 7700– 7706 [CrossRef] [PubMed]
    [Google Scholar]
  37. Yu SH, Kim DH, Kim HS, Nam KH, Choi BK et al. Infectious spondylodiscitis by uncommon pathogens: a pitfall of empirical antibiotics. Korean J Spine 2016; 13: 97– 101 [CrossRef] [PubMed]
    [Google Scholar]
  38. Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum 2009; 39: 10– 17 [CrossRef] [PubMed]
    [Google Scholar]
  39. Duarte RM, Vaccaro AR. Spinal infection: state of the art and management algorithm. Eur Spine J 2013; 22: 2787– 2799 [CrossRef] [PubMed]
    [Google Scholar]
  40. Kim CJ, Kang SJ, Choe PG, Park WB, Jang HC et al. Which tissues are best for microbiological diagnosis in patients with pyogenic vertebral osteomyelitis undergoing needle biopsy?. Clin Microbiol Infect 2015; 21: 931– 935 [CrossRef] [PubMed]
    [Google Scholar]
  41. Gasbarrini A, Boriani L, Salvadori C, Mobarec S, Kreshak J et al. Biopsy for suspected spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 16: 26– 34 [PubMed]
    [Google Scholar]
  42. Fenollar F, Lévy PY, Raoult D. Usefulness of broad-range PCR for the diagnosis of osteoarticular infections. Curr Opin Rheumatol 2008; 20: 463– 470 [CrossRef] [PubMed]
    [Google Scholar]
  43. Lecouvet F, Irenge L, Vandercam B, Nzeusseu A, Hamels S et al. The etiologic diagnosis of infectious discitis is improved by amplification-based DNA analysis. Arthritis Rheum 2004; 50: 2985– 2994 [CrossRef] [PubMed]
    [Google Scholar]
  44. Gras G, Buzele R, Parienti JJ, Debiais F, Dinh A et al. Microbiological diagnosis of vertebral osteomyelitis: relevance of second percutaneous biopsy following initial negative biopsy and limited yield of post-biopsy blood cultures. Eur J Clin Microbiol Infect Dis 2014; 33: 371– 375 [CrossRef] [PubMed]
    [Google Scholar]
  45. Yang SC, Fu TS, Chen HS, Kao YH, Yu SW et al. Minimally invasive endoscopic treatment for lumbar infectious spondylitis: a retrospective study in a tertiary referral center. BMC Musculoskelet Disord 2014; 15: 105 [CrossRef] [PubMed]
    [Google Scholar]
  46. Stengel D, Bauwens K, Sehouli J, Ekkernkamp A, Porzsolt F et al. Systematic review and meta-analysis of antibiotic therapy for bone and joint infections. Lancet Infect Dis 2001; 1: 175– 188 [CrossRef] [PubMed]
    [Google Scholar]
  47. Bernard L, Dinh A, Ghout I, Simo D, Zeller V et al. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet 2015; 385: 875– 882 [CrossRef] [PubMed]
    [Google Scholar]
  48. Kang BU, Lee SH, Ahn Y, Choi WC, Choi YG. Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine 2010; 13: 158– 164 [CrossRef] [PubMed]
    [Google Scholar]
  49. Khan MH, Smith PN, Rao N, Donaldson WF. Serum C-reactive protein levels correlate with clinical response in patients treated with antibiotics for wound infections after spinal surgery. Spine J 2006; 6: 311– 315 [CrossRef] [PubMed]
    [Google Scholar]
  50. Murillo O, Roset A, Sobrino B, Lora-Tamayo J, Verdaguer R et al. Streptococcal vertebral osteomyelitis: multiple faces of the same disease. Clin Microbiol Infect 2014; 20: O33– O38 [CrossRef] [PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000703
Loading
/content/journal/jmm/10.1099/jmm.0.000703
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error