Reply to Werth et al

Spinal Infections: An Update

“…Bacteria can reach the spine and infect the spinal column via the following three routes: (1) hematogenous spread from a remote site, (2) direct external inoculation after trauma (injury or surgery), and (3) dissemination from a contiguous tissue [1]. Hematogenous spread is the most common route for vertebral osteomyelitis in children and adults [22][23][24][25][26][27][28][29]. Generally, any condition that results in circulation of microorganisms into the blood stream (bacteremia) such as surgery or more benign events such as tooth brushing or venipuncture, can lead to hematogenous spondylodiscitis.…”

“…Generally, any condition that results in circulation of microorganisms into the blood stream (bacteremia) such as surgery or more benign events such as tooth brushing or venipuncture, can lead to hematogenous spondylodiscitis. Infection in the urinary tract, often following genitourinary procedures, is the most common source of transient bacteremia and subsequent spinal infection [22][23][24][25][26][27][28][29]. Other common potential primary sources for hematogenous spondylodiscitis include gastrointestinal infections, otitis media, oral cavity infections, infective endocarditis, skin and soft tissue infections, respiratory tract infections, and infected intravenous catheter sites.…”

“…WBC is a less useful laboratory parameter as compared with CRP and ESR, because it is normal in up to 55% of patients with spinal infections [21]. Brucella serology is mandatory in cases with signs and symptoms indicating brucellosis, exposure to a potential source, or in endemic areas [27]. Interferon-gamma (IFN-γ) release assay should be also performed in patients with risk factors for tuberculosis such as immigrants, low socioeconomical status, and endemic countries.…”

The Correlation between Follow-up MRI Findings and Laboratory Results in Pyogenic Spondylodiscitis

“…Monitoring spondylodiscitis can be complex, because the diagnosis is based on clinical, laboratory, and radiologic information. A clinical practice guideline of the Infectious Disease Society of America recommends monitoring systemic inflammatory markers after 4 weeks of antimicrobial therapy (12). Unchanged or increasing values should increase the suspicion for treatment failure.…”

“…Several previous studies have examined the findings and roles of follow-up MRI in spondylodiscitis (9)(10)(11)(19)(20)(21)(22). Although MRI is currently the imaging modality of choice for evaluating spondylodiscitis, its role in follow-up surveillance has not been established (12). Numaguchi Clinical symptoms can be subjective, while laboratory results are not specific to the location of the infection.…”