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Discitis after discography. The role of prophylactic antibiotics
O L Osti1, R D Fraser, B Vernon-Roberts
1Spinal Service and Spinal Injuries Unit, Royal Adelaide Hospital, South Australia.
Abstract:
Discitis after discography is due to bacterial penetration into the intervertebral disc by a contaminated needle and has an incidence of 1% to 4%. We have examined the prophylactic role of cephazolin administered at the time of discography. An experimental study in sheep using radiographic contrast containing Staphylococcus epidermidis showed that either adding the antibiotic to the intradiscal suspension or giving it intravenously 30 minutes before intradiscal inoculation of bacteria prevented any radiographic, macroscopic or histological signs of discitis; all the intervertebral disc cultures were negative. In a prospective clinical study of 127 consecutive patients having lumbar discography, the injected contrast contained cephazolin 1 mg per ml. None of the patients developed clinical or radiographic signs of discitis. We recommend the use of a suitable broad spectrum antibiotic in a single prophylactic dose whenever the intervertebral disc is entered.
Insights
Prophylactic antibiotic use, specifically cephazolin, effectively prevents discitis following discography procedures. This approach significantly reduces the risk of infection associated with intervertebral disc entry.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Pharmacology
Background:
- Discitis, an infection of the intervertebral disc, can occur after discography with an incidence of 1-4%.
- Bacterial contamination via a needle is the primary cause of post-discography discitis.
- The prophylactic role of antibiotics in preventing discitis has been investigated.
Purpose of the Study:
- To evaluate the efficacy of cephazolin as a prophylactic agent against discitis after discography.
- To determine if adding cephazolin to the contrast or administering it intravenously can prevent infection.
Main Methods:
- An experimental study in sheep involved injecting contrast containing Staphylococcus epidermidis, with and without cephazolin.
- Radiographic, macroscopic, and histological assessments were used to detect signs of discitis.
- A prospective clinical study administered cephazolin (1 mg/ml) in the discography contrast for 127 patients.
Main Results:
- In sheep, cephazolin administration (intradiscal or intravenous) completely prevented discitis, with all disc cultures negative.
- No patients in the clinical study developed clinical or radiographic signs of discitis after receiving cephazolin-containing contrast.
Conclusions:
- Prophylactic administration of cephazolin is highly effective in preventing discitis post-discography.
- A single prophylactic dose of a broad-spectrum antibiotic is recommended when entering the intervertebral disc.