Spinal infections with and without hardware: the viewpoint of an infectious disease specialist

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Microbiology

Background:

• Spinal infections are a growing concern, particularly those associated with spinal implants.
• Pyogenic bacteria like Staphylococcus aureus and Escherichia coli are common causes.
• Implant-associated infections are complicated by bacterial biofilm formation, leading to antimicrobial resistance.

Purpose of the Study:

• To review the challenges and treatment strategies for spinal infections, with a focus on implant-associated cases.
• To highlight the role of bacterial biofilms in treatment resistance.
• To emphasize the importance of microbiological diagnosis in guiding therapy.

Main Methods:

• Literature review of spinal infections and implant-associated infections.
• Analysis of causative pathogens and their resistance mechanisms.
• Comparison of treatment approaches for implant-associated versus non-implant spinal infections.

Main Results:

• Spinal infections are increasingly prevalent and challenging to treat.
• Coagulase-negative staphylococci are key pathogens in implant-associated infections due to biofilm production.
• Effective treatment for implant-associated spinal infections necessitates a combination of surgical intervention and antibiotic therapy.

Conclusions:

• Implant-associated spinal infections require aggressive management including surgery and antibiotics.
• Conservative, pathogen-directed antimicrobial therapy is suitable for non-implant spinal infections.
• Empirical antibiotic treatment without microbiological diagnosis should be avoided due to rising antimicrobial resistance.