Postprocedural discitis of the vertebral spine: challenges in diagnosis, treatment and prevention

Journal of Hospital Infection

Volumn 82, Issue 3, 2012, Pages 152-157

  McDermott, H ^a,b   Bolger, C ^a   Humphreys, H ^a,b  

^a ROYAL COLLEGE OF SURGEONS IN IRELAND   (Ireland)

^b BEAUMONT HOSPITAL   (Ireland)

Author keywords

Antibiotics; Combination therapy; Imaging; Postprocedural discitis; Pyogenic discitis

Indexed keywords

ANTIBIOTIC AGENT; BACTERIAL ENZYME; C REACTIVE PROTEIN; CALCITONIN; CEFUROXIME; CLINDAMYCIN; DAPTOMYCIN; FUSIDIC ACID; GENTAMICIN; GENTAMICIN BONE CEMENT; LINEZOLID; QUINOLINE DERIVED ANTIINFECTIVE AGENT; QUINOLONE; RIFAMPICIN; VANCOMYCIN;

ANTIBIOTIC SENSITIVITY; ANTIBIOTIC THERAPY; BACKACHE; BACTERIUM CULTURE; BIOFILM; BLOOD CULTURE; BLOODSTREAM INFECTION; BONE AND JOINT INFECTIONS; BONE INFECTION; CALCITONIN BLOOD LEVEL; CENTRAL NERVOUS SYSTEM INFECTION; CLINICAL FEATURE; CLINICAL TRIAL (TOPIC); COMPUTER ASSISTED TOMOGRAPHY; DEBRIDEMENT; DISKITIS; DNA MICROARRAY; DRUG MEGADOSE; ERYTHROCYTE SEDIMENTATION RATE; FEVER; HUMAN; INFECTION PREVENTION; INTERVERTEBRAL DISK DEGENERATION; LITERATURE; META ANALYSIS; MICROBIOLOGICAL EXAMINATION; MINIMALLY INVASIVE SURGERY; NONHUMAN; NUCLEAR MAGNETIC RESONANCE IMAGING; OSTEOMYELITIS; PATHOGENESIS; POLYMERASE CHAIN REACTION; POSTOPERATIVE INFECTION; POSTPROCEDURAL DISCITIS; PROSTHESIS INFECTION; PROTEIN BLOOD LEVEL; PSEUDOMONAS; REVIEW; RISK FACTOR; SENSITIVITY AND SPECIFICITY; SPINAL CORD DECOMPRESSION; SPINE FUSION; SPINE SURGERY; SPONDYLITIS; STAPHYLOCOCCUS AUREUS; STAPHYLOCOCCUS EPIDERMIDIS; STAPHYLOCOCCUS INFECTION; SURGICAL INFECTION; VERTEBRAL CANAL STENOSIS;

ANTI-BACTERIAL AGENTS; DEBRIDEMENT; DISCITIS; DRUG THERAPY, COMBINATION; HUMANS; POSTOPERATIVE COMPLICATIONS; WORLD HEALTH;

EID: 84867696407     PISSN: 01956701     EISSN: 15322939     Source Type: Journal    
DOI: 10.1016/j.jhin.2012.07.009     Document Type: Review

References (56)

1. An H.S., Seldomridge J.A. Spinal infections. Diagnostic tests and imaging studies. Clin Orthop Relat Res 2006, 444:27-33.
2. Butler J.S., Shelly M.J., Timlin M., Powderly W.G., O'Byrne J.M. Nontuberculous pyogenic spinal infection in adults. A 12-year experience from a tertiary referral centre. Spine 2006, 31:2695-2700.
3. Kowalski T.J., Berbari E.F., Huddleston P.M., Steckelberg J.M., Osmon D.R. Do follow-up imaging examinations provide useful prognostic information in patients with spine infection?. Clin Infect Dis 2006, 43:172-179.
4. Ledermann H.P., Schweitzer M.E., Morrison W.B., Carrino J.A. MR imaging findings in spinal infections: rules or myths. Radiology 2003, 228:506-514.
5. Schimmel J.J.P., Horsting P.P., de Kleuver M., Wonders G., van Limbeek Risk factors for deep surgical site infections after spinal fusion. Eur Spine J 2010, 19:1711-1719.
6. Hopkinson N., Stevenson J., Benjamin S. A case ascertainment study of septic discitis: clinical, microbiological and radiological features. Q J Med 2001, 94:465-470.
7. Silber J.S., Anderson D.G., Vaccaro A.R., Anderson P.A., McCormick P. Management of postprocedural discitis. Spine J 2002, 2:279-287.
8. Dimar J.R., Glassman S.D., Burkus J.K., Pryor P.W., Hardacker J.W., Carreon L.Y. Two-year fusion and clinical outcomes in 224 patients treated with a single-level instrumented posterolateral fusion with iliac crest bone graft. Spine J 2009, 9:880-885.
9. Uçkay I., Teterycz D., Ferry T., et al. Spondylodiscitis due to Propionibacterium acnes: report of twenty-nine cases and a review of the literature. Clin Microbiol Infect 2010, 16:353-358.
10. Bémer P., Corvec S., Tariel S., et al. Significance of Propionibacterium acnes positive samples in spinal instrumentation. Spine 2008, 33:E971-E976.
11. Harris A.E., Hennicke C., Byers K., Welch W.C. Post operative discitis due to Propionibacterium acnes: a case report and review of the literature. Surg Neurol 2005, 63:538-541.
12. Bavinski G., Schoeggl A., Trattnig S., et al. Microsurgical management of postoperative disc infection. Neurosurg Rev 2003, 26:102-107.
13. Asamoto S., Doi H., Kobayashi N., et al. Spondylodiscitis: diagnosis and treatment. Surg Neur 2005, 64:103-108.
14. Dall B.E., Rowe D.E., Odette W.G., Batts D.H. Postoperative discitis. Diagnosis and management. Clin Orthop Relat Res 1987, 224:138-146.
15. Sponseller P.D., Shah S.A., Abel M.F., Newton P.O., Letko L., Marks M. Infection rate after spine surgery in cerebral palsy is high and impairs results. Clin Orthop Relat Res 2010, 468:711-716.
16. Ho C., Sucato D.J., Richards B.S. Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients. Spine 2007, 32:2272-2277.
17. Jiménez-Mejías M.E., de Dios Colmenero J., Sánchez-Lora F.J., et al. Postoperative spondylodiskitis: etiology, clinical findings, prognosis and comparison with nonoperative pyogenic spondylodiskitis. Clin Infect Dis 1999, 29:339-345.
18. O'Toole J.E., Eichholz K.M., Fessler R.G. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine 2009, 11:471-476.
19. Parker S.L., Adogwa O., Witham T.F., Aaronson O.S., Cheng J., McGirt M.J. Post operative infection after minimally invasive versus open versus transforaminal lumbar interbody fusion (TLIF): literature review and cost analysis. Minim Invasive Neurosurg 2011, 54:33-37.
20. Mok J.M., Pekmezci M., Piper S.L., et al. Use of C-reactive protein after spinal surgery. Spine 2008, 33:415-421.
21. Kang B.-U., Lee S.-H., Ahn Y., Choi W.-C., Choi Y.-G. Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine 2010, 13:158-164.
22. Fouquet B., Goupille P., Jattiot F., et al. Discitis after lumbar disc surgery. Features of " aseptic" and " septic" forms. Spine 1992, 17:356-358.
23. Maus U., Anderega S., Gravius S., Ohnsorge J.A., Miltner O. Procalcitonin (PTC) as a diagnostic tool for monitoring of spondylodiscitis. Z Orthop Unfall 2009, 147:59-64.
24. Wagner S.C., Schweitzer M.E., Morrison W.B., Przybylski G.J., Parker L. Can imaging findings help differentiate spinal neuropathic arthropathy from disk space infection? Initial experience. Radiology 2000, 214:693-699.
25. Kowalski T.J., Layton K.F., Berbari E.F., et al. Follow-up MR imaging in patients with pyogenic spine infections: lack of correlation with clinical features. Am J Neuroradiol 2007, 28:693-699.
26. Chaudhary S.B., Vives M.J., Basra S.K., Reiter M.F. Postoperative spinal wound infections and postprocedural diskitis. J Spinal Cord Med 2007, 30:441-451.
27. Enoch D.A., Cargill J.S., Laing R., Herbert S., Corrah T.W., Brown N.M. Value of CT-guided biopsy in the diagnosis of septic discitis. J Clin Pathol 2008, 6:750-753.
28. Sampedro M.F., Huddleston P.M., Piper K.E., et al. A biofilm approach to detect bacteria from removed spinal implants. Spine 2010, 35:1218-1224.
29. Ho C., Skaggs D.L., Weiss J.M., Tolo V.T. Management of infection after instrumented posterior spine fusion in pediatric scoliosis. Spine 2007, 32:2739-2744.
30. Perry A.L., Lambert P.A. Propionibacterium acnes. Lett Appl Microbiol 2006, 42:185-188.
31. Jakab E., Zbinden R., Gubler J., Ruef C., von Graevenitz A., Krause M. Severe infections caused by Propionibacterium acnes: an underestimated pathogen in late postoperative infections. Yale J Biol Med 1996, 69:477-482.
32. Gillard J., Boutoille D., Varin S., Asseray N., Berthelot J.-M., Maugars Y. Suspected disk space infection with negative microbiological tests - report of eight cases and comparison with documented pyogenic discitis. Joint Bone Spine 2005, 72:156-162.
33. Lecouvet F., Irenge L., Vandercam B., Nzeusseu A., Hamels S., Gala J.-L. The etiologic diagnosis of infectious discitis is improved by amplification-based DNA analysis. Arth Rheum 2004, 50:2985-2994.
34. Mok J.M., Guillaume T.J., Talu U., et al. Clinical outcome of deep wound infection after instrumented posterior spinal fusion. Spine 2009, 34:578-583.
35. Hsieh M.-K., Chen L.-H., Niu C.-C., Fu T.-S., Lai P.-L., Chen W.-J. Postoperative anterior spondylodiscitis after posterior pedicle screw instrumentation. Spine J 2011, 11:24-29.
36. Diab M., Smucny M., Dormans J.P., et al. Use and outcomes of wound drain in spinal fusion for adolescent idiopathic scoliosis. Spine 2011, 37:966-973.
37. Legrand E., Flipo R.-M., Guggenbuhl P., et al. Management of nontuberculous infectious discitis. Treatments used in 110 patients admitted to 12 teaching hospitals in France. Joint Bone Spine 2001, 68:504-509.
38. Grados F., Lescure F.X., Senneville E., Flipo R.M., Schmit J.L., Fardellone P. Suggestions for managing pyogenic (non tuberculous) discitis in adults. Joint Bone Spine 2007, 74:133-139.
39. Roblot F., Besnier J.M., Juhel L., et al. Optimal duration of antibiotic therapy in vertebral osteomyelitis. Semin Arthritis Rheum 2007, 36:269-277.
40. Collins I., Wilson-MacDonald J., Chami G., et al. The diagnosis and management of infection following instrumented spinal fusion. Eur Spine J 2008, 17:445-450.
41. Burdette S.D. Daptomycin for methicillin-resistant Staphylococcus aureus infections of the spine. Spine J 2009, 9:e5-e8.
42. Pepin J., Saheb N., Coulombe M.A., et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile associated diarrhoea: a cohort study during an epidemic in Quebec. Clin Infect Disease 2005, 41:1254-1260.
43. Rde W.T., Batten J.J., Want S., McCarthy I.D., Brown M., Hughes S.P. A new in vitro model to investigate antibiotic penetration of the intravertebral disc. J Bone Joint Surg Br 1995, 77-B:967-970.
44. Komatsu M., Takahata M., Sugawara M., et al. Penetration of linezolid into rabbit intervertebral discs and surrounding tissues. Eur Spine J 2010, 19:2149-2155.
45. Walters R., Moore R., Fraser R. Penetration of cephazolin in human lumbar intervertebral disc. Spine 2006, 31:567-570.
46. Conaughty J.M., Khurana S., Banovac K., Martinez O.V., Eismont F.J. Antifungal penetration into normal rabbit nucleus pulposus. Spine 2004, 29:E289-E293.
47. Nau R., Sörgel F., Eiffert H. Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections. Clin Microbiol Rev 2010, 23:858-883.
48. Daver N.G., Shelburne S.A., Atmar R.L., et al. Oral step-down therapy is comparable to intravenous therapy for Staphylococcus aureus osteomyelitis. J Infect 2007, 54:539-544.
49. Conaughty J.M., Chen J., Martinez O.V., Chiapetta G., Brookfield K.F., Eismont F.J. Efficacy of linezolid versus vancomycin in the treatment of methicillin-resistant Staphylococcus aureus discitis. Spine 2006, 31:E830-E832.
50. Barker F.G. Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery 2002, 51:391-401.
51. Brown E.M., Pople I.K., deLouvois J., et al. Prevention of postoperative infection in patients undergoing spinal surgery. Spine 2004, 29:938-945.
52. Riley L.H., Banovac K.M., Octavio M.V., Eismont F.J. Tissue distribution of antibiotics in the intervertebral disc. Spine 1994, 19:2619-2625.
53. Cai H.-X., Liu C., Fan S.-W. Routinely using prophylactic antibiotic may not effectively prevent intervertebral disc infection: a new strategy to preventing postoperative intervertebral disc infection. Med Hypoth 2011, 76:464-466.
54. McHugh S.M., Collins C.J., Corrigan M.A., Hill A.D.K., Humphreys H. The role of topical antibiotics used as prophylaxis in surgical site infection prevention. J Antimicrob Chemother 2011, 66:693-701.
55. Borkhuu B., Borowski A., Shah S.A., Littleton A.G., Dabney K.W., Miller F. Antibiotic-loaded allograft decreases the rate of acute deep wound infection after spinal fusion in cerebral palsy. Spine 2008, 33:2300-2304.
56. O'Neill K.R., Smith J.G., Abtahi A.M., et al. Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder. Spine J 2011, 11:641-646.