Management of infectious discitis. Outcome in one hundred and eight patients in a University Hospital

Abstract

Purpose The optimal management of pyogenic discitis is not agreed on. We conducted a retrospective, cross-sectional, observational study in which all patients with discitis who attended Hospital San Carlos Madrid from January 1999 to January 2009 were included. Methods We identified 108 consecutive adult patients with infectious discitis. There were 49 men and 59 women with an average age of 67,5 (+/-16,89) years in the study group. Mean follow-up interval was 6,06 (12,5-2) years. 78 patients had spontaneous discitis and 30 patients had postoperative discitis. Inclusion criteria for the review were illness compatible with vertebral infection and / or evidence of spinal involvement on magnetic resonance imaging (MRI). Results In 56 percutaneous discal biopsy (52% patients) were positive in 28 cases. A single disc was infected in 100 patients. The segments involved were the cervical spine in four, the thoracic spine in 38 and the lumbar spine in 66. One or more comorbid diseases were present in 73 (68%) of 108 patients. Diabetes mellitus was the most common disease. Comorbid disease was rapidly fatal in four patients, ultimately fatal in seven patients, and nonfatal or not present in 97 patients (90 %). Conclusion Early diagnosis is a major challenge. Heightened awareness and the prompt use of MRI are necessary to avoid diagnostic delay. Prolonged antimicrobial therapy and the judicious application of timely surgical intervention are essential for an optimal outcome. Introduction and epidemiology

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

“…The reported systemic antibiotic treatment duration ranged between 6 and 40 weeks [4,30,35]. Despite antibiotic treatment, additional surgery was required in 25-55 % of the reported cases [4,30]. Relapse rates of 2 and 4 % after antibiotics treatment only were reported in two studies.…”

“…Four studies were of a more descriptive nature and reported the outcome after antibiotic therapy [4,30,35,37]. The reported systemic antibiotic treatment duration ranged between 6 and 40 weeks [4,30,35]. Despite antibiotic treatment, additional surgery was required in 25-55 % of the reported cases [4,30].…”

“…Antibiotics therapy could be targeted on the causative bacteria in 792 (89 %) of the cases. Four studies were of a more descriptive nature and reported the outcome after antibiotic therapy [4,30,35,37]. The reported systemic antibiotic treatment duration ranged between 6 and 40 weeks [4,30,35].…”

“…This resulted in 25 included studies (Table 3). Ten studies containing only a minority of tuberculosis or postoperative infection cases (2.9-38 %) were included in the review [16][17][18][27][28][29][30][31][32][33]. At total of 75 patients in the current review had tuberculosis and 52 patients had a postoperative infection, which represented, respectively, 3.1 and 2.2 % of all included patients.…”

“…Six studies have evaluated the effect of systemic antibiotic treatment alone (Table 5) [4,30,31,35,37,38]. Antibiotics therapy could be targeted on the causative bacteria in 792 (89 %) of the cases.…”