Article
Antibiotic therapy in surgically treated pyogenic vertebral discitis: is a 6 weeks therapy accessible?
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Authors
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Jasmin Scorzin
- Bonn, Deutschland
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Azize Boström
- Bonn, Deutschland
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Hartmut Vatter
- Rheinische Friedrich-Wilhelms-Universität, Neurochirurgische Klinik, Bonn, Deutschland
| Published: | June 9, 2017 |
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Outline
Text
Objective: There are no guidelines according to antibiotic treatment duration (ATD) for surgically treated patients with pyogenic vertebral discitis. Although recently there is evidence that a 6 weeks antibiotic treatment is not inferior to a 12 weeks treatment in conservatively treated patients. Since then, we liberalized our former rigid 12 weeks treatment to a feasible 6 weeks treatment. Most surgeons end the antibiotic treatment according to clinical appearance, normalized infection parameters like C-reactive protein (CRP) and radiological survey in the follow-up. We retrospectively investigated our surgically treated patients with pyogenic vertebral discitis (PVD) since 2015 for the difference in ATD.
Methods: We searched our local database for patients who matched the criteria for PVD. 50 patients were surgically treated to reduce the infection mass and to fuse the affected segments over a period of 20 months. In cases with identification of the pathogen targeted antibiotic therapy was performed. Otherwise an empirical antibiotic therapy was started. The patient’s surgeon decided about the intended ATD before discharge. In the follow-up the patients' clinical appearance, CRP measurements and MRI findings were collected to decide about the termination of antibiotic therapy. Intended follow-up was after 6 and 12 weeks.
Results: In 25 cases (m : f =16 : 9; mean age 73 yrs) the acquired follow-up visits (at least one follow-up), CRP measurements and MRI were available for further investigation. In 14/25 cases (56%) we intended to treat < 12 weeks. In 5/14 patients (36%) the ATD was < 12 weeks and as intended. 9/14 patients (64%) had ATD longer than intended, 2 patients (14%) remained still below 12 weeks and the other 7 patients exceeded 12 weeks of ATD. Overall 50% of cases, which were intended to treat < 12 weeks, effectively received antibiotic therapy for less than 12 weeks.
Conclusion: There is lack of evidence regarding the optimal duration of antibiotic treatment as well as regarding the appropriate follow-up parameters in surgically treated patients with PVD. In our collective at least 50 % of patients could receive antibiotic therapy shorter than 12 weeks when initially intended so. We think a antibiotic treatment duration less than 12 weeks in surgically treated PVD is possible in a considerable number of cases and needs to be discussed further.
