Microbiologic Diagnosis of Pyogenic Spondylitis

Abstract

Pyogenic spondylitis requires long-term antibiotics treatment and identification of the etiologic microorganism is essential. The first test in the microbiologic diagnosis of pyogenic spondylitis is a blood culture. Any microorganisms that grow in blood culture are highly likely to be the etiological microorganisms of pyogenic spondylitis. If the microbial etiology cannot be defined by the blood culture, a needle biopsy is performed on the inflamed tissues. Here, it is recommended that paraspinal tissues, rather than spinal tissues, are collected to increase the positive rate in tissue culture. If the microbial etiology cannot be defined by the first needle biopsy, another needle biopsy may be performed. The collected tissue sample is used in culture tests on bacteria and mycobacteria as well as pathological tests. If tuberculous spondylitis is suspected, polymerase chain reaction is carried out to detect Mycobacterium tuberculosis . In the case that the etiological microorganisms cannot be identified, the data of the patient regarding age, sex, vertebrae involved, history of spinal surgery or procedure, previous or concurrent urinary tract or intra-abdominal infection are analyzed. Based on this the most probable microbial etiology is determined to select the antibiotics to be used in the empiric treatment.

Pyogenic spondylitis caused by Klebsiella pneumoniae: should the possibility of hypervirulent Klebsiella pneumoniae be considered?

“…The most common organism responsible for pyogenic spondylitis infections is Staphylococcus aureus [5]. The proportion of gram-negative organisms is 10-30%, compared to 60-80% of gram-positive bacteria [6][7][8][9][10]. Among the gram-negative bacteria, Escherichia coli is the most common, followed by Klebsiella pneumoniae, which accounts for 1-5% of all infections [6][7][8][9][10].…”

“…The proportion of gram-negative organisms is 10-30%, compared to 60-80% of gram-positive bacteria [6][7][8][9][10]. Among the gram-negative bacteria, Escherichia coli is the most common, followed by Klebsiella pneumoniae, which accounts for 1-5% of all infections [6][7][8][9][10]. Intraabdominal and urinary tract infections (UTIs) are the most common source of pyogenic spondylitis caused by gram-negative bacteria [8,11].…”

Association of pyogenic spondylitis with congestive heart failure in Korea: a nationwide longitudinal cohort study

“…Thus, we suggest that the high incidence of CHF in PS may be related to the high association between IE and PS. Although there are several studies showing that CHF is one of the most common underlying diseases that accompanies PS [26,27], there has been no further studies discussing their relationship which is why studies of PS and its link to both IE and CHF should be conducted.…”

Pyogenic spondylitis caused by Klebsiella pneumoniae: Should the possibility of hypervirulent Klebsiella pneumoniae be considered?

“…The proportion of gram-negative organisms is 10-30%, compared to 60%-80% of gram-positive bacteria [6][7][8][9][10]. Among the gram-negative bacteria, Escherichia coli is the most common, followed by Klebsiella pneumoniae, which accounts for 1-5% of all infections [6][7][8][9][10]. Intra-abdominal and urinary tract infections (UTIs) are the most common source of pyogenic spondylitis caused by gram-negative bacteria [8,11].…”

“…The most common organism responsible for pyogenic spondylitis infections is Staphylococcus aureus [5]. The proportion of gram-negative organisms is 10-30%, compared to 60%-80% of gram-positive bacteria [6][7][8][9][10]. Among the gram-negative bacteria, Escherichia coli is the most common, followed by Klebsiella pneumoniae, which accounts for 1-5% of all infections [6][7][8][9][10].…”