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Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis
Published on: May 23, 2021
Evolving Approach to Antibiotic Treatment of Pediatric Spondylodiscitis
Doron Mulla1, Yoel Levinsky1, Nufar Marcus1
1Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
Insights
Transitioning pediatric patients with spondylodiscitis from intravenous to oral antibiotics early shortens hospital stays and treatment duration. This approach is clinically appropriate, reducing complications without significant negative impact.
Area of Science:
- Pediatric Infectious Diseases
- Pediatric Orthopedics
- Clinical Microbiology
Background:
- Intervertebral spondylodiscitis (IS) is a serious infection affecting the spine in children.
- Current treatment often involves prolonged intravenous (IV) antibiotic therapy.
- Optimizing treatment duration can improve patient outcomes and resource utilization.
Purpose of the Study:
- To characterize clinical features of pediatric thoracic and lumbar intervertebral spondylodiscitis.
- To evaluate the impact of transitioning from prolonged IV antibiotics to a shorter, clinically guided IV-to-oral regimen.
- To assess clinical outcomes and complications associated with different treatment durations.
Main Methods:
- Retrospective study of 124 pediatric patients (0-18 years) with imaging-confirmed thoracic and lumbar IS (2000-2022).
- Comparison of patients receiving longer IV antibiotic courses versus those on a shorter, clinically directed IV-to-oral regimen.
- Analysis of clinical symptoms, laboratory findings (ESR, CRP), hospitalization duration, and treatment complications.
Main Results:
- Common symptoms included irritability and pain during diaper changes; elevated ESR was the most frequent lab finding (95%).
- Implementing a shorter IV-to-oral regimen significantly decreased median hospitalization from 12 to 8 days (P=.008) and IV treatment duration from 14 to 8 days (P<.001).
- Only 1.6% in the shorter-treatment group required rehospitalization, while prolonged IV treatment was associated with complications in 7.3% of patients.
Conclusions:
- Early transition to oral antibiotics for pediatric spondylodiscitis is clinically appropriate.
- This approach effectively shortens hospital stay and IV antibiotic duration.
- The modified treatment strategy demonstrates minimal negative clinical impact and reduces treatment-related complications.
Objective:
To describe for intervertebral spondylodiscitis (IS) its clinical characteristics, treatment approaches with intravenous (IV) antibiotics, and clinical implications of changes in treatment approach.
Study Design:
This retrospective study included all children aged 0-18 years diagnosed with imaging-confirmed thoracic and lumbar IS from 2000 to 2022 at a tertiary pediatric hospital. Patients with longer IV treatment regimen were compared with those with a shorter clinically directed IV to oral regimen.
Results:
In all, 124 cases were included with median age 14.9 months (IQR, 12.7-19.4 months) at diagnosis. Irritability and pain while changing diapers were common symptoms (52.4% and 49.2%, respectively). Elevated erythrocyte sedimentation rate (ESR) was the most common laboratory finding (95%; median, 50 mm/h [IQR 34-64 mm/h]). Elevated erythrocyte sedimentation rate was found in higher proportions (95%) compared with elevated C-reactive protein (76%; median, 1.8 mg/dL; P < .001). Since implementing the shorter clinically directed IV treatment duration for patients with thoracic and lumbar IS, hospitalization duration was decreased from a median of 12 to 8 days (P = .008) and IV treatment duration by a median of 14 to 8 days (P < .001). Only 1 patient (1.6%) in the clinically directed treatment group required rehospitalization owing to failure of therapy. Conversely, 9 of 124 children in the cohort suffered from IV treatment-related complications; all had been treated IV for prolonged periods.
Conclusions:
Early transition to oral treatment in pediatric spondylodiscitis seems to be appropriate clinically and shortens hospital stay and IV treatment duration without major negative clinical impact.
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