Suggestions for managing pyogenic (non-tuberculous) discitis in adults

Area of Science:

• Infectious Diseases
• Rheumatology
• Radiology

Background:

• Pyogenic discitis and vertebral osteomyelitis (PDVO) are serious spinal infections requiring prompt diagnosis and management.
• Current management guidelines are often based on limited evidence, highlighting the need for expert-driven recommendations.

Purpose of the Study:

• To develop evidence-based recommendations for the identification of causative organisms in PDVO.
• To establish guidelines for appropriate imaging studies in PDVO diagnosis and monitoring.
• To recommend optimal pharmacological and non-pharmacological treatment strategies for adult PDVO patients.

Main Methods:

• Recommendations were drafted by a rheumatologist and an infectiologist based on personal experience and a literature review.
• A comprehensive search of Medline was conducted using relevant keywords for spinal infections.
• The drafted recommendations underwent validation by four independent experts in the field.

Main Results:

• Eighty-five articles were selected for review; no prospective randomized controlled trials were identified.
• Antimicrobial therapy should generally start after pathogen identification, utilizing a combination of two bactericidal, synergistic antimicrobials for at least 12 weeks.
• Routine initial imaging includes spinal and chest radiographs and spinal MRI; follow-up imaging is guided by clinical response.

Conclusions:

• The developed recommendations aim to enhance the quality and consistency of PDVO management.
• Expert opinion and descriptive studies formed the basis of these recommendations.
• Further high-level evidence, particularly from prospective randomized multicenter studies, is needed to refine treatment protocols.