[Adjuvant systemic antibiotic therapy for surgically treated spondylodiscitis]

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Pharmacology

Context:

• Spondylodiscitis treatment relies on systemic antibiotics, yet specific recommendations vary significantly.
• Surgical intervention is common, particularly in older adults (60-80 years) with lumbar spine involvement.
• Delayed diagnosis (>1 month) is prevalent, with 60% of patients untreated upon hospital admission.

Purpose:

• To establish a guideline for adjuvant antibiotic therapy in surgically treated spondylodiscitis cases.
• To analyze patient data, including germ status, localization, extent, and antibiotic treatment.
• To standardize therapy without compromising quality or effectiveness.

Summary:

• The study analyzed 276 surgically treated spondylodiscitis cases (1998-2011) and 20 treated with a standardized regimen (2012-2013).
• Staphylococcus aureus, often multi-drug resistant, was the predominant pathogen. Diabetes mellitus was a common comorbidity (approx. 50%).
• Calculated antibiotic therapy (CAT) with clindamycin demonstrated efficacy, particularly against Staphylococcus aureus, with treatment duration of at least 12 weeks recommended.

Impact:

• Highlights the effectiveness of clindamycin-based calculated antibiotic therapy (CAT) for spondylodiscitis.
• Recommends antibiotic treatment for at least 12 weeks, guided by culture and sensitivity testing.
• Emphasizes considering spondylodiscitis in diabetic patients with back pain and elevated inflammatory markers and reducing diagnostic delays.