Artikel
Spondylodiscitis by multiresistent bacteria – a single center experience of 15 cases
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Veröffentlicht: | 4. Juni 2012 |
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Objective: The treatment of spondylodiscitis is still a controversially discussed issue. To date there are no guidelines for surgical treatment and treatment strategies of pyogenic spinal infections with multiresistant bacteria.
Methods: We performed a retrospective review of patients presenting with spondylodiscitis due to multiresistant bacteria between 2006 and 2010.
Results: 15 patients were found (13 MRSA, 2 ESBL). The mean age at presentation was 63 year, 10 patients were male (69%). All patients presented with pain. Neurological deficit was found in 6 (40%) cases. Epidural abscess was found in 6 (40%) cases. Mean duration of hospital stay was 30 ± 13 days. Distribution of the inflammation: lumbar in 6 (40%), thoracic in 4 (27%) and cervical in 3 (20%) cases. Two patients (13%) had two concomitant non-contiguous spondylodiscitis in different segments of the spine. C-reactive protein was elevated in all cases with a mean of 10.3 ± 7.7 mg/dl. Leukocyte count was elevated in 6 (46%) cases. The main source of inflammation was previous spine surgery (53%). All patients in this series underwent surgical debridement with instrumentation of the spine. Postoperative intravenous antibiotics were administered for 19 ± 8 days followed by 3.1 ± 0.3 months of oral antibiotics. At three months complete healing of the inflammation was achieved in 14 (93%) of cases. One patient had a relapse of the inflammation following dorsal instrumentation, only. This was followed by an anterior debridement and interbody fusion upon relapse. Out of the 6 patients with neurological deficit, two had full recovery and two had improved incompletely after surgery.
Conclusions: Staged surgical immobilisation and instrumentation and debridement within the disc space is a reliable approach to achieve complete healing of spinal inflammation with multiresistant bacteria. Even with multiresistent bacteria, a relatively short period of intravenous antibiotics of 3 weeks is followed by a 3 months of oral antibiotics is appropriate in most cases.