ORIGINAL ARTICLEManagement of nontuberculous infectious discitis. Treatments used in 110 patients admitted to 12 teaching hospitals in France
Introduction
Although antibiotic therapy is associated with a full recovery in the overwhelming majority of cases of pyogenic discitis, the optimal treatment modalities are not agreed on. The introduction 10 years ago of percutaneous discal and vertebral biopsy (PDVB) has improved the rate of identification of the causative organism in patients with discitis 〚1〛. Antibiotics characterized by good intraosseous penetration and oral bioavailability (fluoroquinolones, fusidic acid, and rifampin) are now available and, when used in combination, effectively prevent the emergence during therapy of resistant mutant strains 2, 3. These advances might make oral, short-course antibiotic therapy a reasonable option, the advantages being better patient comfort and lower hospitalization-related costs. However, little is known about the management of discitis in everyday practice. Most large series were conducted in a single center 4, 5 and provided limited data on treatment options. No randomized trials of short-course (< 2 months) antibiotic therapy have been published to date. We conducted a multicenter observational study of the management of patients with pyogenic discitis admitted in 1997 to 12 networked teaching hospitals.
Section snippets
Patient inclusion
This retrospective, cross-sectional, observational study was conducted in 12 teaching hospital rheumatology departments. Starting in January 1997, each department included the first ten patients admitted for pyogenic discitis. The patients were not selected based on the nature of the pyogenic organism, the treatments used, or the outcome (recovery, death, unavailability for follow-up).
Diagnostic criteria
The diagnosis of pyogenic discitis was based either on identification of a pyogenic organism in a PDVB specimen
The study population
One hundred ten patients met all inclusion and exclusion criteria, 67 men and 43 women, with a mean age of 60.6 ± 13.7 years (range, 17–86). A single disk was infected in 98 patients: the segment involved was the cervical spine in three, the thoracic spine in 15, the thoracolumbar junction in eight, the lumbar spine in 61, and the lumbosacral junction in 11. Two disks were infected in 11 patients and four in one patient. The discitis was iatrogenic in 28 (25.5%) patients and occurred after disk
Discussion
This cross-sectional, retrospective, multicenter study included 110 patients managed for pyogenic discitis at 12 teaching hospitals. The clinical and laboratory test findings were similar to those in earlier reports 4, 5, 6, 7, 8, 9. Mean age was nearly 60 years, and the lumbar spine was predominantly affected. One-fourth of cases were iatrogenic. PDVB and/or blood cultures recovered the causative organism in three-quarters of cases, and methicillin-susceptible S. aureus was the most common
Acknowledgements
We thank Searle Pharmaceuticals (Monsanto France SA) for providing logistic support for the research activities of the Rheumatology Network Organization.
References (11)
Critères microbiologiques et pharmacologiques du choix des antibiotiques dans le traitement des infections ostéo-articulaires
Med Mal Infect
(1991)- et al.
Infectious discitis diagnostic contribution of laboratory tests and percutaneous discovertebral biopsy. A review of one hundred twenty cases
Rev Rhum 〚Engl Ed〛
(1996) - et al.
Critères microbiologiques et pharmacologiques du choix des antibiotiques
- et al.
Antibiothérapie curative des spondylodiscites iatrogènes
- et al.
Spondylodiscites infectieuses: Analyse d’une série de 105 cas
Rev Rhum Mal Ostéoartic
(1992)
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