Adjuvant Systemic Antibiotic Therapy for Surgically Treated Spondylodiscitis

Recognised methods for the treatment of spondylodiscitis in correspondence to the immobilisation are systemic antibiotic therapy. However, the available data for recommendations of specific antibiotic therapy are very heterogeneous. The aim of this study was to focus on the adjuvant antibiotic therapy in surgical treated cases of spondylodiscitis and to reach a guideline regarding its application in patients' spondylodiscitis. Between 01.10.1998 and 31.12.2011 276 inpatient cases of spondylodiscitis were surgically treated, documented and included in the study. The study involved medical history, germ status, localisation and extent of spondylodiscitis and antibiotic treatment. Between 01.01.2012 and 31.12.2013 a further 20 cases of spondylodiscitis were treated according to a standardised treatment regimen of antibiotic therapy and included in the study. The age distribution shows a marked prominence of 60 to 80 year-olds, with a leading localisation of spondylodiscitis in the lumbar spine with 55% followed by the thoracic spine (33%) and the cervical spine (12%). A constant observation during the study periods was the delayed diagnosis of more than 1 month of spondylodiscitis, so that about 60% of the patients were not receiving any treatment for their disease at the time of hospitalisation. The aetiology of spondylodiscitis is very heterogeneous and remained unknown in 34% of cases. However, diabetes mellitus appeared as a disease favouring the occurrence of spondylodiscitis since it was concomitant with almost 50% of patients with spondylodiscitis. The bacterial spectrum is limited in our area to staphylococci, with a predominance of Staphylococcus aureus. At least about 10% of the germs are multi-drug resistant. In 45% of cases, pathogen detection was unsuccessful. Clindamycin is the most commonly used antibiotic in the treatment of spondylodiscitis and is used in 26.8% in combinations with other antibiotics. The antibiotic therapy is administered for at least for 3 months. The significant decrease in inflammatory markers in the course of treatment shows the positive response of patients to therapy. The recommendations for antibiotic treatment of spondylodiscitis are very heterogeneous, so our goal is to standardise the therapy without reducing the quality and effectiveness of treatment. The results show that the calculated antibiotic therapy (CAT) with clindamycin is reasonable in the treatment of spondylodiscitis especially with the predominance of Staphylococcus aureus as pathogen. In addition, suitable antibiotic therapy should be administered in correspondence to a culture and sensitivity testing and should be maintained for at least 12 weeks, even when a reduction of inflammatory markers by 50% after 2 weeks has already been achieved. It is noteworthy to point out the high probability of coexistence of spondylodiscitis with diabetes mellitus, so that spondylodiscitis should always be considered in diabetic patients with back pain and increased levels of inflammatory markers. A significant reduction in the very long time until reaching a definitive diagnosis should be achieved.