Appropriate duration of post-surgical intravenous antibiotic therapy for pyogenic spondylodiscitis

Yun-Da Li, Chak-Bor Wong, Tsung-Ting Tsai, Po-Liang Lai, Chi-Chien Niu, Lih-Huei Chen, Tsai-Sheng Fu, Yun-Da Li, Chak-Bor Wong, Tsung-Ting Tsai, Po-Liang Lai, Chi-Chien Niu, Lih-Huei Chen, Tsai-Sheng Fu

Abstract

Background: Most guidelines recommend 6 to 12 weeks of parenteral antibiotic treatment for pyogenic spondylodiscitis. When surgical debridement is adequately performed, further intravenous antibiotic treatment duration can be reduced than that of conservative treatment alone theoretically. However, the appropriate duration of post-surgical parenteral antibiotic treatment is still unknown. This study aimed to identify the risk factors of recurrence and evaluate the appropriate duration after surgical intervention.

Methods: This 3-year retrospective review included 102 consecutive patients who were diagnosed with pyogenic spondylodiscitis and underwent surgical intervention. Recurrence was defined as recurrent signs and symptoms and the need for another unplanned parenteral antibiotic treatment or operation within one year. This study included two major portions. First, independent risk factors for recurrence were identified by multivariable analysis, using the database of demographic information, pre-operative clinical signs and symptoms, underlying illness, radiographic findings, laboratory tests, intraoperative culture results, and treatment. Patients with any one of the risk factors were considered high-risk; those with no risk factors were considered low-risk. Recurrence rates after short-term (≤3 weeks) and long-term (> 3 weeks) parenteral antibiotic treatment were compared between the groups.

Results: Positive blood culture and paraspinal abscesses were identified as independent risk factors of recurrence. Accordingly, 59 (57.8%) patients were classified as low-risk and 43 (42.2%) as high-risk. Among the high-risk patients, a significantly higher recurrence rate occurred with short-term than with long-term antibiotic therapy (56.2% vs. 22.2%, p = 0.027). For the low-risk patients, there was no significant difference between short-term and long-term antibiotic therapy (16.0% vs. 20.6%, p = 0.461).

Conclusions: The appropriate duration of parenteral antibiotic treatment in patients with pyogenic spondylodiscitis after surgical intervention could be guided by the risk factors. The duration of postoperative intravenous antibiotic therapy could be reduced to 3 weeks for patients without positive blood culture or abscess formation.

Keywords: Blood culture; Parenteral antibiotic duration; Postoperative antibiotic therapy; Pyogenic spondylodiscitis; Recurrent risk factors; Spinal abscess.

Conflict of interest statement

Ethics approval and consent to participate

This retrospective study was approved by the institutional review board of Chang Gung Memorial Hospital (Institutional Review Board of Chang Gung Medical Foundation Reference Number: 103-6277B). The data was de-identified and hence consent was waived. The need for consent was waived by the institutional review board of Chang Gung Memorial Hospital (Reference Number: 103-6277B).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of patients who met the inclusion/exclusion criteria for the study population
Fig. 2
Fig. 2
Pie chart showing the percentage of the bacterial populations isolated during surgery. Abbreviations: MSSA, methicillin-susceptible Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; CoNS, Coagulase-negative staphylococci
Fig. 3
Fig. 3
Recurrence rates in patients at low and high risk of recurrence according to the duration of parenteral antibiotic treatment after surgical intervention. There was a significant difference in recurrence according to the duration of parenteral antibiotic treatment after surgery among the high-risk patients, though there was no statistically significant difference in recurrence among the low-risk group
Fig. 4
Fig. 4
Suggestion of the optimal duration of parenteral antibiotic treatment in patients with pyogenic spondylodiscitis after surgical intervention. Patients with either positive blood culture or paraspinal abscess should be given parenteral antibiotic treatment for more than 3 weeks after surgical intervention. A short duration (≤3 weeks) of parenteral antibiotic treatment may be sufficient for the patients without risk factors

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Source: PubMed

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