Intervertebral disc penetration by antibiotics used prophylactically in spinal surgery: implications for the current standards and treatment of disc infections

Abstract

Purpose The presence of Propionibacterium acnes in a substantial component of resected disc specimens obtained from patients undergoing discectomy or microdiscectomy has led to the suggestion that this prominent human skin and oral commensal may exacerbate the pathology of degenerative disc disease. This hypothesis, therefore, raises the exciting possibility that antibiotics could play an important role in treating this debilitating condition. To date, however, little information about antibiotic penetration into the intervertebral disc is available. Methods Intervertebral disc tissue obtained from 54 microdiscectomy patients given prophylactic cefazolin (n = 25), clindamycin (n = 17) or vancomycin (n = 12) was assayed by high-performance liquid chromatography, with cefaclor as an internal standard, to determine the concentration of antibiotic penetrating into the disc tissue. Results Intervertebral disc tissues from patients receiving the positively charged antibiotic clindamycin contained a significantly greater percentage of the antibacterial dose than the tissue from patients receiving negatively charged cefazolin (P < 0.0001) and vancomycin, which has a slight positive charge (P < 0.0001). Conclusion Positively charged antibiotics appear more appropriate for future studies investigating potential options for the treatment of low-virulence disc infections. Graphical abstract These slides can be retrieved under Electronic Supplementary Material. Key points [cefazolin; degenerative disc disease; clindamycin; vancomycin; surgical prophylaxis] 1. Propionibacterium acnes infection very likely exacerbates the pathology of degenerative disc disease (DDD); an appropriate antibiotic therapy is needed. 2. Intervertebral disc tissue from 54 patients given prophylactic cefazolin (25), clindamycin (17) or vancomycin (12) were assayed to determine the concentration of antibiotic in the disc tissue 3. Positively charged clindamycin more readily penetrated the disc tissue than negatively charged cefazolin.

Colonization of intervertebral discs by Cutibacterium acnes in patients with low back pain: Protocol for an analytical study with microbiological, phenotypic, genotypic, and multiomic techniques

“…Colonization of LIVD by C . acnes in patients with LDD supports the bacterial hypothesis of LBP [ 4 , 8 , 29 , 45 – 47 ]. The determination of a molecular profile for these patients will not only contribute to a better understanding of the pathophysiological basis of LBP associated with LDD [ 41 – 43 ], but it will also positively interfere in the clinical management of this common condition, rationalizing its treatment and optimizing its costs.…”

“…LBP is a common complaint in the general population, and its incidence is about five times higher in patients with LDD and Modic endplate changes [1,2]. The link between these findings and the isolation of low virulence pathogens in LIVD has already been described in several studies, generating a lot of interest in the topic and promoting the bacterial hypothesis of LDD [3][4][5][6][7][8][9][10][11][12][13][14].…”

Colonization of intervertebral discs byCutibacterium acnesin patients with low back pain: protocol for an analytical study with microbiological, phenotypic, genotypic, and multiomic techniques

“…Colonization of LIVD by C. acnes in patients with LDD supports the bacterial hypothesis of LBP (4,8,29,(45)(46)(47). The determination of a molecular profile for these patients will not only contribute to a better understanding of the pathophysiological (41)(42)(43), but it will also positively interfere in the clinical management of this common condition, rationalizing its treatment and optimizing its costs.…”

“…(1,2) The link between these findings and the isolation of low virulence pathogens in LIVD has already been described in several studies, generating a lot of interest in the topic and promoting the bacterial hypothesis of LDD. (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) Albert et al reported 46% of positive cultures for anaerobes in 61 patients undergoing lumbar discectomy, of which 80% had Modic type 1 changes. (15) Other studies corroborate these findings, with high identification rates for Cutibacterium acnes, an anaerobic and aerotolerant pathogen that is bacillus-shaped, stained by the Gram method, pleomorphic, non-spore-forming, and a biofilm producer.…”

Optimizing the Safety of Intradiscal Platelet-Rich Plasma: An in Vitro Study with Cutibacterium Acnes

“…In a study by Intravia et al, cefazolin antimicrobial activity against several strains of bacteria was compared with the antimicrobial activity of PRP with and without leukocytes, but the antibiotic was a separate experimental arm in the study and not examined directly in combination with the PRP as an injectate component [25]. Since disc penetration of certain prophylactic antibiotics can be poor following intravenous administration [26], intradiscal administration of antibiotics may be required for efficacy during this and similar procedures in the clinic.…”