The Use of Intradiscal Antibiotics for Discography: an in vitro Study of Gentamicin, Cefazolin, and Clindamycin

Klessig, Heidi; Showsh, Sasha A.; Sekorski, Amy

doi:10.1097/01.brs.0000087301.71177.85

Cited by 42 publications

(18 citation statements)

References 13 publications

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“…Therefore, the previous experiments by Klessig et al [26] are confirmed, in principle, by our in vitro tests. The occurrence of a chemical discitis after intradiscal injection of antibiotics has so far not been proven in animal studies or in patients [17,18,20,21,23,31].…”

Section: Discussionsupporting

confidence: 73%

“…A synergistic effect between gentamicin and iohexol against E. coli, as described in the experiments of Klessig et al [26], could not be confirmed in our study. In addition, two more non-ionic RCM were tested, including one new dimeric compound, iosimenol, which is not yet commercially available.…”

Section: Discussioncontrasting

confidence: 55%

“…Our in vitro experiments also showed the inhibition of bacterial growth by the three non-ionic RCM alone. In addition to the mild antimicrobial effect of iohexol found by Klessig et al [26], iodixanol and the new dimeric contrast medium iosimenol alone inhibited bacterial growth at high concentrations (low dilutions), mainly at dilution 1, which is equivalent to 150 mg iodine ml -1 , and also for some bacterial strains at dilution 2. This indicates that the concentrations of RCM containing approximately 300 mg iodine ml -1 should be employed.…”

Section: Discussionmentioning

confidence: 99%

“…In order to avoid increasing bacterial resistance to systemically administered antibiotics [14,26], intradiscally injected antibiotics might be an alternative owing to the direct application of the antibiotic into the disc. One study on the efficacy of antibiotics in combination with iohexol has already been conducted by Klessig et al [26].…”

mentioning

confidence: 99%

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In vitroassessment of the antibiotic efficacy of contrast media and antibiotics and their combinations at various dilutions

Langer

Usmani²,

Gorkom³

et al. 2010

BJR

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ABSTRACT. Discography is a controversial diagnostic procedure involving the injection of radiographic contrast medium (RCM) into the intervertebral disc. Iatrogenic bacterial discitis is a rare but serious complication. The intervention has been increasingly performed in our patients here in the United Arab Emirates. Prophylactic intravenous antibiotic administration can reduce post-interventional discitis; however, this may favour the development of bacterial resistance. Direct intradiscal injection of an antibiotic together with the RCM is a potential alternative. To date, there has been only one study on the efficacy of antibiotics added to an RCM. Equally, there are only limited data regarding the potential direct effect of RCM on bacterial growth. The purpose of this study was to determine whether the efficacy of antibiotics is affected when RCM are added. In an in vitro study, the effect of non-ionic RCM on the growth of five laboratory bacterial strains, alone and in combination with three broadspectrum antimicrobials, was tested. Bacterial growth was assessed in the absence and the presence of RCM, antibiotics and their combinations. All three RCM alone demonstrated some inhibition of bacterial growth at high concentrations. In the presence of the RCM, all three antibiotics retained their inhibitory effect on bacterial growth. In conclusion, our in vitro experiments did not reveal any changes in the antimicrobial efficacy of the three antibiotics in the presence of the three tested RCM. Subsequent clinical trials will need to assess whether intradiscal antibiotic administration may be a suitable substitute for, or a supplement to, prophylactic systemic antibiotics before discography.

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Section: Discussionsupporting

confidence: 73%

Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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In vitroassessment of the antibiotic efficacy of contrast media and antibiotics and their combinations at various dilutions

Langer

Usmani²,

Gorkom³

et al. 2010

BJR

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show abstract

“…31,32 Because discitis can be classified as potentially catastrophic, the 1999 CDC Guideline for Prevention of Surgical Site Infection supports the use of routine antimicrobial prophylaxis during discography and other intradiscal treatment techniques. 15 There are only limited animal data available to guide the selection of antimicrobial agent and the route of administration for prophylaxis during discography and intradiscal treatments.…”

Section: Antibiotic Prophylaxis During Discographymentioning

confidence: 99%

Infectious Risks of Chronic Pain Treatments: Injection Therapy, Surgical Implants, and Intradiscal Techniques

Rathmell

Lake

Ramundo

2006

Regional Anesthesia and Pain Medicine

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Discography

Calodney

Vest²

2022

Regenerative Medicine

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The Use of Intradiscal Antibiotics for Discography: an in vitro Study of Gentamicin, Cefazolin, and Clindamycin

Abstract: This study supports the use of intradiscal antibiotics for prophylaxis of disc space infection during discography. lntradiscal placement of antibiotic should obviate the need for systemic antibiotic prophylaxis and its attendant risk of generating antimicrobial resistance.

Cited by 42 publications

References 13 publications

In vitroassessment of the antibiotic efficacy of contrast media and antibiotics and their combinations at various dilutions

In vitroassessment of the antibiotic efficacy of contrast media and antibiotics and their combinations at various dilutions

Infectious Risks of Chronic Pain Treatments: Injection Therapy, Surgical Implants, and Intradiscal Techniques

Discography

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