Pyogenic Vertebral Osteomyelitis: Clinical Features, Diagnosis, and Treatment

Kwon, Ji-Woong; Hyun, Seung-Jae; Han, Soonhung; Kim, Ki-Jeong; Jahng, Tae-Ahn

doi:10.14245/kjs.2017.14.2.27

Cited by 39 publications

(45 citation statements)

References 99 publications

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“…Fluoroquinolones, clindamycin, rifampicin, fusidic acid, and metronidazole have good levels of penetration into bone tissue. However, beta-lactam antibiotics and glycopeptides can reach moderate levels, and the bone tissue penetration of aminoglycoside group pharmaceuticals remains insufficient (15,17).…”

Section: █ Discussionmentioning

confidence: 99%

“…In the literature, some studies suggest that broad-spectrum antibiotics with anti-staphylococcal activity should be recommended in patients in which PVO is suspected, considering the possible causative microorganisms (9,15,17). While methicillin resistance is common in nosocomial-acquired Staphylococcus aureus strains, this resistance is less common in community-acquired strains.…”

Section: █ Discussionmentioning

confidence: 99%

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Evaluation of empirical antibiotic treatment in culture-negative pyogenic vertebral osteomyelitis

Doğan

Şimşek²,

Yılmaz³

et al. 2019

Turkish Neurosurgery

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AIM: To investigate the efficacy of empirical antibiotic treatment in culture-negative pyogenic vertebral osteomyelitis (PVO) cases. MATERIAL and METHODS: The records of patients with culture-negative PVO who were treated at infectious disease and neurosurgery outpatient clinics in the past four years were examined retrospectively. The control group comprised healthy subjects with similar age, gender, and body mass index but without pathology. In the statistical evaluation of the obtained data, the comparison of the groups was performed by analysis of variance. Statistical significance was accepted as p<0.05. RESULTS: No statistically significant difference in the white blood cell count and erythrocyte sedimentation rate was found between the spondylodiscitis and the healthy subject groups when the blood parameters obtained before and after the treatment (p>0.05). However, a statistical significance was assessed in the results of the comparison for C-reactive protein (p<0.05). CONCLUSION: In the context of evidence-based medicine and the rational use of antibiotics, it is clear that antibiotics should be preferred according to the culture antibiogram results in the treatment of infectious diseases.

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Section: █ Discussionmentioning

confidence: 99%

Section: █ Discussionmentioning

confidence: 99%

Evaluation of empirical antibiotic treatment in culture-negative pyogenic vertebral osteomyelitis

Doğan

Şimşek²,

Yılmaz³

et al. 2019

Turkish Neurosurgery

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“…Die pyogene Spondylodiszitis wird dementsprechend im Durchschnitt erst 6 Monate nach dem Auftreten erster klinischer Zeichen diagnostiziert; bei der tuberkulösen Form dauert es im Mittel 12 Monate [26]. Insofern werden bei Verdacht Laborwerte und die Resultate bildgebender Verfahren zur weiteren Abklärung benötigt [27,28].…”

Section: Klinische Diagnostikunclassified

“…Streptokokken werden teilweise bis zu 19 % isoliert. Bei den gramnegativen Erregern treten besonders E. coli, P. aeruginosa, Proteus mirabilis auf [28]. Anaerobe Keime (3 %) besiedeln die Wirbelsäule vor allem bei penetrierenden Traumen.…”

Section: Mikrobiologische Diagnostikunclassified

Spondylitis – Spondylodiscitis – an Update

et al. 2018

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Spondylodiscitis is an infection of the intervertebral disc with subsequent infection of the adjacent vertebral bodies. The main causes are 3 pathogen groups: bacteria, particularly tuberculosis pathogens, fungi and parasites. In pyogenic spondylodiscitis, infections with Staphylococcus aureus are the most common, with an incidence of up to 80%. Mortality is around 2 - 3%. Infections with tuberculosis are often associated with psoas and paravertebral abscesses. Neurological deficits are registered in up to 50% of patients. For microbiological diagnostic testing, blood cultures are used for aerobic and anaerobic bacteria. However, histological examination leads significantly more frequently to positive pathogen detection. In tissue samples, results with 16S rRNA PCR results are clearly superior to results from microbiological examination. The MRI exhibits high sensitivity and specificity and is therefore superior to other radiological methods. Elimination of the infection, pain reduction and stabilisation of the spine are the main objectives of any treatment. A standardised antibiotic therapy for spondylodiscitis has not been clearly defined. Pathogen detection is important, with focused antibiotic therapy. Antibiotic therapy should initially be administered intravenously for 2 - 4 weeks. This should be followed by oral administration for 6 - 12 weeks. In the case of antibiotic-resistant infections with neurological deficiencies, it is recommended to perform a surgical procedure, with careful debridement and instrumentation as well as i. v. administered antibiotics for 3 weeks followed by three month oral antibiotic treatment. Surgical procedures are indicated with neurological deficits, progressive increase in spinal deformities, failure of conservative therapy with insufficient pain relief and unreliable pathogen identification. The selection of the surgical procedure should mainly be based on the extent and localisation of bone destruction and the individual circumstances of the patients. The prognosis is good if there is a clear reduction in CRP and ESR in the first few weeks.

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“…Nach Flückiger et al (5) scheinen auch durch Staphylococcus aureus verursachte Spondylodiszitiden mit einer erhöhten Mortalität verbunden zu sein. Die Gesamtmortalität wird um die fünf Prozent (zwei bis elf Prozent) angegeben (16,34). Untersuchungen konnten weiter zeigen, dass die allgemeine Lebensqualität und Zufriedenheit dieser Patienten auch nach Ausheilung der Infektion im Vergleich zu einem Normalkollektiv reduziert bleibt.…”

Section: Prognoseunclassified

Die bakterielle unspezifische “pyogene” Spondylodiszitis

Heyde¹

2017

Osteologie

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ZusammenfassungAus einer Reihe von Gründen nimmt die Häufigkeit der unspezifischen bakteriellen ,,pyogenen“ Spondylodiszitis zu. Verschiedenste Risikofaktoren und Komorbiditäten erhöhen das Erkrankungsrisiko. Trotz verbesserter und z. T. standardisierter Diagnosealgorithmen erfolgt die Diagnose häufig mit einer gewissen Verzögerung. Je nach Befund und Allgemeinzustand ist eine konservative oder operative Therapie abzuwägen. Eine, wenn möglich gezielte und ausreichend lange Antibiotikatherapie ist obligat, dabei kommt einem Erregernachweis eine hohe Bedeutung zu. Das Ziel der Therapie ist eine Ausheilung der Infektion bei einer gut belastbaren, schmerzarmen bzw. schmerzfreien Wirbelsäule ohne neurologische Defizite. Dafür gibt es heute eine Reihe therapeutischer Ansätze. Trotzdem ist die Erkrankung mit einer erhöhten Mortalität und einer relevanten Morbidität verbunden.

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Pyogenic Vertebral Osteomyelitis: Clinical Features, Diagnosis, and Treatment

Cited by 39 publications

References 99 publications

Evaluation of empirical antibiotic treatment in culture-negative pyogenic vertebral osteomyelitis

Evaluation of empirical antibiotic treatment in culture-negative pyogenic vertebral osteomyelitis

Spondylitis – Spondylodiscitis – an Update

Die bakterielle unspezifische “pyogene” Spondylodiszitis

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