Abstract
BackgroundMost guidelines recommend 6 to 12 weeks of parenteral antibiotic treatment for pyogenic spondylodiscitis. When surgical debridement is adequately performed, further intravenous antibiotic treatment duration can be reduced than that of conservative treatment alone theoretically. However, the appropriate duration of post-surgical parenteral antibiotic treatment is still unknown. This study aimed to identify the risk factors of recurrence and evaluate the appropriate duration after surgical intervention.MethodsThis 3-year retrospective review included 102 consecutive patients who were diagnosed with pyogenic spondylodiscitis and underwent surgical intervention. Recurrence was defined as recurrent signs and symptoms and the need for another unplanned parenteral antibiotic treatment or operation within one year. This study included two major portions. First, independent risk factors for recurrence were identified by multivariable analysis, using the database of demographic information, pre-operative clinical signs and symptoms, underlying illness, radiographic findings, laboratory tests, intraoperative culture results, and treatment. Patients with any one of the risk factors were considered high-risk; those with no risk factors were considered low-risk. Recurrence rates after short-term (≤3 weeks) and long-term (> 3 weeks) parenteral antibiotic treatment were compared between the groups.ResultsPositive blood culture and paraspinal abscesses were identified as independent risk factors of recurrence. Accordingly, 59 (57.8%) patients were classified as low-risk and 43 (42.2%) as high-risk. Among the high-risk patients, a significantly higher recurrence rate occurred with short-term than with long-term antibiotic therapy (56.2% vs. 22.2%, p = 0.027). For the low-risk patients, there was no significant difference between short-term and long-term antibiotic therapy (16.0% vs. 20.6%, p = 0.461).ConclusionsThe appropriate duration of parenteral antibiotic treatment in patients with pyogenic spondylodiscitis after surgical intervention could be guided by the risk factors. The duration of postoperative intravenous antibiotic therapy could be reduced to 3 weeks for patients without positive blood culture or abscess formation.
Highlights
Most guidelines recommend 6 to 12 weeks of parenteral antibiotic treatment for pyogenic spondylodiscitis
Whereas scientific evidence is rich for conservative treatment about the optimal duration of systemic antibiotics, limited data are available regarding the appropriate duration of postoperative parenteral antibiotic treatment for patients who underwent surgical intervention
Adult patients (≥ 18 years of age) who were diagnosed with infectious spondylodiscitis and who underwent surgical intervention and antibiotic treatment were included
Summary
Most guidelines recommend 6 to 12 weeks of parenteral antibiotic treatment for pyogenic spondylodiscitis. Most guidelines recommend 6 to 12 weeks of intravenous antibiotic treatment as the standard of care in uncomplicated pyogenic spondylodiscitis [1, 5, 8,9,10,11]. Whereas scientific evidence is rich for conservative treatment about the optimal duration of systemic antibiotics, limited data are available regarding the appropriate duration of postoperative parenteral antibiotic treatment for patients who underwent surgical intervention. It is unclear whether there is an association between intravenous antibiotic treatment duration and treatment failure after surgical intervention. Parenteral antibiotic therapy should be limited as possible due to a prolonged intravenous antibiotic therapy increases unnecessary costs, the frequency of adverse events, and antibiotic resistance [13,14,15]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
