Artikel
6-week antibiotic therapy in surgically treated pyogenic vertebral discitis – an interim evaluation
6 wöchige Antibiotika-Therapie bei operativen Spondylodiszitis Patienten – eine Zwischenauswertung
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Veröffentlicht: | 8. Mai 2019 |
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Objective: There are no guidelines regarding to antibiotic treatment duration for surgically treated patients with pyogenic spondylodiscitis. There is evidence that a 6 weeks antibiotic treatment (AT) is not inferior to 12 weeks treatment in conservatively treated patients. We changed our former 12 weeks treatment to 6 weeks protocol since 4/2017.
Methods: 45 patients were admitted to our hospital for pyogenic spondylodiscitis between 4/2017 and 11/2018. 40 patients were surgically treated with decompression and fusion technique. 6 patients died due to septic complications. In 8 of 34 cases (23.5%) the location was in the cervical spine, in 13 cases (28.2%) in the lumbar spine, in 3 cases (8.8%) in the lumbosacral region and 6 patients had multiple locations. 58.8% of the cases were associated with an epidural empyema, 47.1% with a paravertebral abscess and 26.5% had a septic constellation. Antibiotic therapy was started with clindamycin and ceftriaxone except where the antibiotic therapy had to be adapted due to microbiological aspects or to pre-existing antibiotic regime. 55.9% of the patients had pre-existing antibiotics at the time of admittance. In 50% staphylococcus aureus was the detected pathogen. Other germs were coagulase negative staphylococci (42.9%) and streptococci (14.3%). Multiple pathogens existed in 17.9%. The follow-up visits were scheduled for the 6th, 12th and 52nd weeks.
Results: 29 data sets were available for this interim analysis. In 24 of 29 (82.8%) we applied 6 weeks antibiotic therapy according to our protocol. 17.2% were lost because of passing over to other therapists. 20 cases (58.8%) had available follow-up. Mean follow-up was 25.8 weeks. In 10 of 20 cases (50%) the actual antibiotic therapy was 6+/-1 weeks, in 2 cases the actual treatment was 8 weeks, in one case it was 9 weeks. In 7 cases (35%) the antibiotics were administered 12 weeks or more. In 4/7 cases we decided not to follow the treatment protocol ab initio because of additional co-infections and high C-reactive protein (CRP) levels, in 2 cases (10%) the duration was secondarily extended because of a delayed drop-off of CRP levels. In 1 case the decision for a 12 weeks therapy stays unclear.
Conclusion: We had no surgical revisions because of recurring or infection of adjacent spinal segments. One patient had revision surgery because of dislocation of thoracic screws after 6 months.