gms | German Medical Science

64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. - 29. Mai 2013, Düsseldorf

Empiric antibiotic treatment in sontaneous and iatrogenic spinal infections – five year period data of a spine department

Meeting Abstract

  • Frank W. Floeth - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf; Klinik für Wirbelsäule und Schmerz, St.-Vinzenz Krankenhaus, Düsseldorf
  • Sven Eicker - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • Hans-Jakob Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • Jörg Herdmann - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf; Klinik für Wirbelsäule und Schmerz, St.-Vinzenz Krankenhaus, Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMO.01.03

doi: 10.3205/13dgnc003, urn:nbn:de:0183-13dgnc0030

Veröffentlicht: 21. Mai 2013

© 2013 Floeth et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: In the initial phase of empiric antibiotic treatment in spinal infections the knowledge of both the community and hospital specific bacterial pathogens and their antibiotic resistance status is essential.

Method: Prospective evaluation of spinal infections admitted to a non-university community hospital from 2007 to 2011. On average 1000 operative and 600 conservative cases were treated by the hospitals spine clinic and 12.000 single diagnostic or therapeutic spinal injections were administered per year. In all cases contrast enhanced MR imaging, blood cultures and specimen collection from the infected area was performed before standard antibiotic treatment (Clindamycin 4x600mg/d and Cefuroxime 3x1,5g/d iv) was started.

Results: Overall 85 infections were detected in the five year period, 70% located in the lumbar spine and 15% each in the thoracic and cervical spine. There were 65% abscesses and 35% cases of spondylodiscitis. 60% of the infections were spontaneous (10/y => 0,63% of all admittances), 34% postsurgical (6/y => 0,6% of all operations) and 6% after infiltration (1/y => 0,008% of all spinal injections). Initial elevation of C-reactive protein was found in 100%, leukocytosis in 43% and fever in 18% of the patients. Isolation of a pathogen agent was possible in 68 patients (80%) while in 17 patients (20%) no species was found. In 65% the agent was found only in the specimen of the infected focus, in 28% in both specimen and blood culture and in 7% in blood culture only. In 62% the blood cultures were positive in the absence of fever. The most frequent agents were Staphylococcus aureus (50%) and epidermidis (13%) followed by Enterococcus (10%) and Streptococcus species (7%). MRSA was isolated in 3%. The standard antibiotic treatment turned out to be effective according to patients resistogram in 63 of 68 cases with isolated pathogen (93%) and effective according to patients clinical course and lab values in 16 of 17 cases (94%) without detection of a pathogen. Resitant species were only found in postoperative infections but not in spontaneous or post infiltration infections.

Conclusions: CRP elevation is the key lab marker in spinal infections while leucocytosis is often absent and fever is rarely seen. Blood cultures even in the absence of fever and collection of specimens of infected tissue are essential for detection of the infectious agent. Initial empiric antibiotic treatment using Clindamycin and Cefuroxime turned out to be effective in the vast majority of spinal infections.