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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

6-week antibiotic therapy in surgically treated pyogenic vertebral discitis – an interim evaluation

6 wöchige Antibiotika-Therapie bei operativen Spondylodiszitis Patienten – eine Zwischenauswertung

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Jasmin E. Scorzin - Universitätsklinikum Bonn, Klinik für Neurochirurgie, Bonn, Deutschland
  • Mohammed Banat - Universitätsklinikum Bonn, Klinik für Neurochirurgie, Bonn, Deutschland
  • Hartmut Vatter - Universitätsklinikum Bonn, Klinik für Neurochirurgie, Bonn, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP146

doi: 10.3205/19dgnc483, urn:nbn:de:0183-19dgnc4837

Veröffentlicht: 8. Mai 2019

© 2019 Scorzin et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

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.