Elsevier

Joint Bone Spine

Volume 68, Issue 6, December 2001, Pages 504-509
Joint Bone Spine

ORIGINAL ARTICLE
Management of nontuberculous infectious discitis. Treatments used in 110 patients admitted to 12 teaching hospitals in France

https://doi.org/10.1016/S1297-319X(01)00315-3Get rights and content

Abstract

The optimal management of pyogenic discitis is not agreed on. No randomized clinical trials of short-course or oral antibiotic regimens have been published to date. To shed light on this issue, we reviewed the management of patients admitted for pyogenic discitis to one of 12 networked rheumatology departments. In this cross-sectional observational study, each department included the first ten patients admitted starting in January 1997 for treatment of pyogenic discitis. One hundred ten patients met the inclusion criteria, 67 men and 43 women, with a mean age of 60.6 ± 13.7 years (range, 17–86 years). Mean time from symptom onset to diagnosis was 39.6 ± 39.8 days (range, 24 h–240 days). Blood cultures were positive in 47.3% of patients, and the percutaneous discal and vertebral biopsy in 63.6% of cases; these two investigations identified the causative organism in 79 cases (72.8%). Mean duration of the rheumatology department stay was 31.3 ± 14.1 days (range, 4–78 days). Antibiotics were given intravenously to 103 (93.6%) patients, for a mean of 25.5 ± 17.6 days (range, 4–124 days); duration of intravenous antibiotic therapy was longer than 4 weeks in 36.5% of patients. Only seven (6.4%) patients received primary oral antibiotics with no parenteral antibiotics. One hundred patients were given oral antibiotics at the same time as and after intravenous antibiotics, for a mean duration of 87.2 ± 43.6 days (range, 20–278 days); Bracing was used in 98 (89.1%) patients. Although antibiotic selection was rational and in agreement with current recommendations, wide differences were noted across centers regarding intravenous treatment duration, hospital stay duration, and total treatment duration.

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)

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