Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980–1990

Jensen, Allan; Espersen, Frank; Skinhøj, Peter; Rosdahl, Vibeke Thamdrup; Frimodt‐Møller, Niels

doi:10.1016/s0163-4453(97)92395-1

Cited by 162 publications

(112 citation statements)

References 19 publications

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“…25,29 Other Gram-positive organisms such as S. epidermidis and Streptococcus species are the second most common ones. 18,25 Since the introduction of antibiotics, though, there has been a relative increase in infections caused by Gram-negative bacteria such as Escherichia coli and diphtheroids.…”

Section: Microbiologymentioning

confidence: 99%

“…25 There appears to be an increasing incidence of spinal infections in recent years; this disease is now estimated to occur in approximately 1 per 100,000 persons annually. 10,29 This rise can be attributed to the increasing prevalence of elderly and immunocompromised individuals in the population. 13 Cervical osteomyelitis most often affects patients in the fifth through seventh decades of life.…”

mentioning

confidence: 99%

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Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine

Acosta

Chin

Quiñones‐Hinojosa³

et al. 2004

FOC

111

119

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Establishing the diagnosis of cervical osteomyelitis in a timely fashion is critical to prevent catastrophic neurological injury. In the modern imaging era, magnetic resonance imaging in particular has facilitated the diagnosis of cervical osteomyelitis, even before the onset of neurological signs or symptoms. Nevertheless, despite advancements in diagnosis, disagreement remains regarding appropriate surgical treatment. The role of instrumentation and type of graft material after cervical decompression remain controversial. The authors describe the epidemiological features, pathogenesis, and diagnostic evaluation, and the surgical and nonsurgical interventions that can be used to treat osteomyelitis of the cervical spine. They also review the current debate about the role of instrumentation in preventing spinal deformity after surgical decompression for cervical osteomyelitis. Based on this review, the authors conclude that nonsurgical therapy is appropriate if neurological signs or symptoms, instability, deformity, or spinal cord compression are absent. Surgical decompression, debridement, stabilization, and deformity correction are the goals once the decision to perform surgery has been made. The roles of autogenous graft, instrumentation, and allograft have not been clearly delineated with Class I data, but the authors believe that spinal stability and decompression override creating an environment that can be completely sterilized by antibiotic drugs.

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Section: Microbiologymentioning

confidence: 99%

mentioning

confidence: 99%

Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine

Acosta

Chin

Quiñones‐Hinojosa³

et al. 2004

FOC

111

119

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“…Generally three types of spondylodiscitis are recognized; pyogenic, granulomatous (tuberculous, brucellar, aspergillar, and fungal), and parasitic [2,4]. In the mid twentieth century, the majority of the reported cases in literature consisted of granulomatous infections with up to 59 % of the cases caused by Mycobacterium tuberculosis [3,5,6]. The name granulomatous spondylodiscitis is somewhat misleading since spinal tuberculosis typically involves the vertebral bodies and to lesser extent the intervertebral disks.…”

Section: Introductionmentioning

confidence: 99%

“…The name granulomatous spondylodiscitis is somewhat misleading since spinal tuberculosis typically involves the vertebral bodies and to lesser extent the intervertebral disks. Nowadays, only 24 % is caused by tuberculosis and the vast majority of the cases of spinal infections are pyogenic [3,5,6]. Besides a relative increase in pyogenic spondylodiscitis, there also appears to be an increase in the total incidence [1,3,7,8].…”

Section: Introductionmentioning

confidence: 99%

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

et al. 2015

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Background Spondylodiscitis is a spinal infection affecting primarily the intervertebral disk and the adjacent vertebral bodies. Currently many aspects of the treatment of pyogenic spondylodiscitis are still a matter of debate. Purpose The aim of this study was to review the currently available literature systematically to determine the outcome of patients with pyogenic spondylodiscitis for conservative and surgical treatment strategies. Methods A systematic electronic search of MEDLINE, EMBASE, Cochrane Collaboration, and Web of Science regarding the treatment of pyogenic spondylodiscitis was performed. Included articles were assessed on risk of bias according the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and strength of recommendation was evaluated according the GRADE approach. Results 25 studies were included. Five studies had a high or moderate quality of evidence. One RCT suggest that 6 weeks of antibiotic treatment of pyogenic spondylodiscitis results in a similar outcome when compared to longer treatment duration. However, microorganism-specific studies suggest that at least 8 weeks of treatment is required for S. aureus and 8 weeks of Daptomycin for MRSA. The articles that described the outcome of surgical treatment strategies show that a large variety of surgical techniques can successfully treat spondylodiscitis. No additional long-term beneficial effect of surgical treatment could be shown in the studies comparing surgical versus antibiotic only treatment. Conclusion There is a strong level of recommendation for 6 weeks of antibiotic treatment in pyogenic spondylodiscitis although this has only been shown by one recent RCT. If surgical treatment is indicated, it has been suggested by two prospective studies with strong level of recommendation that an isolated anterior approach could result in a better clinical outcome.

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“…Although improvements in surgical and radiological techniques together with modern antimicrobial therapy have dramatically diminished the morbidity and mortality of the disease, no well-designed randomised trial for its treatment has been published, although spinal surgical infections have been covered [23]. Furthermore, its incidence, although rare, is increasing up to four to 24 cases per million per year due to better diagnosis [33], intravenous drug use, a rise in health care-associated infection, e.g. via haemodyalisis [8], and acute and elective spinal surgery [14].…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of spondylodiscitis. An update

Guerado

Cerván

2012

International Orthopaedics (SICOT)

192

132

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Concept Spondylodiscitis refers to an infection affecting the intervertebral disk, the vertebral body or the posterior arch of the vertebra being aetiologically, pyogenic, granulomatous (tuberculosis, brucellosis, or fungal infection) or parasitic. Diagnosis Spondylodiscitis diagnosis is based on clinical symptoms, a combination of erythrocyte sedimentation rate with C-reactive protein (CRP) tests and, less useful, leukocytosis. Blood culture is also a very cost-effective method of identifying organisms. Plain radiographs are useful, however changes may take several months to appear. Radionuclide tests are currently less used; nevertheless, fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) shows encouraging results particularly when magnetic resonance images (MRI) are unconvincing in the distinction between degenerative changes and infection. MRI with gadolinium enhancement is the choice for image diagnosis. Management Medical management is usually the basis for treatment, alone or in combination with surgery. Surgical approach, either by endoscopy or open, is indicated for biopsy when clinical evolution is unsatisfactory and no micro-organism has been isolated, and also whenever a root, spinal cord or dural compression is seen on MRI; spinal instability or severe deformity are also clear indications for surgical treatment. Less invasive surgery either CT-scan guided or, particularly, by endoscopy has good results. However open surgery is still the standard. The anterior approach allows for anterior disc and bone debridement. The posterior approach is indicated when posterior elements are involved or in the presence of an epidural abscess. Although good results have been claimed, the use of instrumentation in the presence of an infected focus is controversial, as the use of cages or BMPs are.

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Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980–1990

Cited by 162 publications

References 19 publications

Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine

Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

Surgical treatment of spondylodiscitis. An update

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