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[Evidence and recommendation of empirical antimicrobial treatment in pyogenic spondylodiscitis: systematic review]
David Agustín Cordero-Delgado1, Alfredo Javier Moheno-Gallardo, Rubén Torres-González
1Departamento Clínico de Columna, Hospital de Ortopedia, Unidad Médica de Alta Especialidad "Victorio de la Fuente Narváez", Instituto Mexicano del Seguro Social, Ciudad de México. jose.perezata@imss.gob.mx.
Background:
Pyogenic spondylodiscitis is the infectious process that affects the vertebral body and the intervertebral disc. It has an incidence between 2 and 7%. To prescribe antibiotic treatment, it is required to identify the causative organism on the basis of the epidemiology of the etiologic agent, as well as the ability of the antibiotic to penetrate the bone tissue and the intervertebral disc. The objective was to identify the level of evidence and the grade of recommendation for the empiric initial treatment.
Methods:
A systematic review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria. PubMed articles were evaluated to assess their level of evidence and the grade of recommendation according to the Jadad scale and the classification of Sackett. On the basis of those two scales, it was analyzed the agreement by two observers and a Kappa value of 0.750 (p = 0.0001) was considered statistically significant.
Results:
642 studies were analyzed, out of which only 19 met the inclusion criteria. In these it was identified a level of evidence 4 and a degree of recommendation C for the use of fluoroquinolones in association with rifampicin in the empirical treatment of pyogenic spondylodiscitis and the use of vancomycin for the treatment of methicillin-resistant strains.
Conclusion:
There is not enough information concerning the use of empiric antibiotics in pyogenic spondylodiscitis; however, the existing information is favorable, even though it is not conclusive.
Insights
Empiric antibiotic treatment for pyogenic spondylodiscitis, an infection of the spine, shows a level of evidence 4 and recommendation C. Further research is needed for conclusive treatment guidelines.
Area of Science:
- Infectious Diseases
- Orthopedics
- Pharmacology
Background:
- Pyogenic spondylodiscitis affects the vertebral body and intervertebral disc, with an incidence of 2-7%.
- Effective antibiotic treatment requires understanding causative organisms, epidemiology, and antibiotic penetration into bone and disc tissue.
- Identifying evidence-based empiric treatment is crucial for managing this condition.
Purpose of the Study:
- To systematically review and assess the level of evidence and grade of recommendation for empiric antibiotic treatment in pyogenic spondylodiscitis.
Main Methods:
- A systematic review adhering to PRISMA criteria was performed.
- PubMed articles were evaluated for evidence level (Jadad scale) and recommendation grade (Sackett classification).
- Inter-observer agreement was assessed using the Kappa statistic (Kappa = 0.750, p = 0.0001).
Main Results:
- Out of 642 studies, 19 met inclusion criteria.
- A level of evidence 4 and recommendation grade C was identified for empiric treatment with fluoroquinolones plus rifampicin.
- Vancomycin was recommended for methicillin-resistant strains.
Conclusions:
- Current evidence for empiric antibiotic treatment in pyogenic spondylodiscitis is limited but suggests favorable outcomes.
- The existing data, while not conclusive, supports specific antibiotic regimens.
- Further high-quality studies are necessary to establish definitive treatment guidelines.
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