Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec;33(12):4672-4681.
doi: 10.1007/s00586-024-08526-w. Epub 2024 Oct 17.

Factors prolonging antibiotic duration and impact of early surgery in thoracolumbar pyogenic spondylitis treated with minimally invasive posterior fixation

Hisanori Gamada  1   2 , Toru Funayama  3   4 , Yosuke Ogata  1   5 , Takane Nakagawa  1 , Takahiro Sunami  1 , Kotaro Sakashita  1 , Shun Okuwaki  1 , Kaishi Ogawa  6 , Yosuke Shibao  2 , Hiroshi Kumagai  7 , Katsuya Nagashima  8 , Kengo Fujii  6 , Yosuke Takeuchi  8 , Masaki Tatsumura  8 , Itsuo Shiina  9 , Masafumi Uesugi  10 , Masao Koda  1
Affiliations

Factors prolonging antibiotic duration and impact of early surgery in thoracolumbar pyogenic spondylitis treated with minimally invasive posterior fixation

Hisanori Gamada et al. Eur Spine J. 2024 Dec.

Abstract

Purpose: A standard 6-12-week course of antibiotics is recommended for pyogenic spondylitis. Recent evidence supports early minimally invasive posterior fixation surgery; however, its effect on antibiotic treatment duration is unclear. This study aims to identify factors associated with prolonged antibiotic treatment in thoracolumbar pyogenic spondylitis patients resistant to conservative treatment and assess whether early surgery can reduce treatment duration.

Methods: We retrospectively reviewed 74 patients with thoracolumbar pyogenic spondylitis undergoing minimally invasive posterior fixation at nine facilities. Patients were grouped based on antibiotic duration (≥ 6 or < 6 weeks) and timing of surgery (≤ 3 weeks or > 3 weeks of starting antibiotics). Univariable and multivariable logistic regression analyses were used to identify factors associated with prolonged antibiotic treatment and study the outcomes of patients undergoing early surgery.

Results: Forty-nine patients (66%) required prolonged antibiotic treatment. The presence of an iliopsoas abscess (p = 0.0006) and elevated C-reactive protein (CRP) levels (≥ 10 mg/dL, p = 0.015) were independently associated with prolonged antibiotic treatment. Early surgery significantly reduced total antibiotic duration (5.3 weeks vs. 9.9 weeks, p < 0.0001) without increasing the incidence of postoperative infection recurrences and unplanned additional surgeries. Despite factors associated with prolonged antibiotic treatment, early surgery consistently shortened the treatment duration compared to late surgery.

Conclusions: Early surgery (within three weeks) with minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis is associated with reduced antibiotic duration and overall treatment duration regardless of the presence of prolonging factors like iliopsoas abscess and elevated CRP levels.

Keywords: Antibiotics treatment; Minimally invasive spine surgery; Multicenter study; Posterior fixation; Pyogenic spondylitis.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethical approval: The institutional review board of Ibaraki Western Medical Center (protocol code No. 21 − 07, approved on January 27, 2022) approved all procedures, including the review of patient records. All procedures were performed in accordance with the Declaration of Helsinki. All patients provided written informed consent. The IRB approved the procedures outlined for obtaining consent for this study. Competing interests: The authors have no competing interests to declare that are relevant to the content of this article.

References

    1. Nickerson EK, Sinha R (2016) Vertebral osteomyelitis in adults: an update. Br Med Bull 117:121–138. https://doi.org/10.1093/bmb/ldw003 - DOI - PubMed
    1. Yoshimoto M, Takebayashi T, Kawaguchi S, Tsuda H, Ida K, Wada T, Yamashita T (2011) Pyogenic spondylitis in the elderly: a report from Japan with the most aging society. Eur Spine J 20:649–654. https://doi.org/10.1007/s00586-010-1659-4 - DOI - PubMed
    1. Kramer A, Thavarajasingam SG, Neuhoff J, Ponniah HS, Ramsay DSC, Demetriades AK, Davies BM, Shiban E, Ringel F (2023) Epidemiological trends of pyogenic spondylodiscitis in Germany: an EANS spine section study. Sci Rep 13:20225. https://doi.org/10.1038/s41598-023-47341-z - DOI - PubMed - PMC
    1. Yoon SH, Chung SK, Kim K-J, Kim H-J, Jin YJ, Kim HB (2010) Pyogenic vertebral osteomyelitis: identification of microorganism and laboratory markers used to predict clinical outcome. Eur Spine J 19:575–582. https://doi.org/10.1007/s00586-009-1216-1 - DOI - PubMed
    1. Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, Hendershot EF, Holtom PD, Huddleston PM, Petermann GW, Osmon DR, Infectious Diseases Society of America (2015) 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in Adultsa. Clin Infect Dis 61:e26–e46. https://doi.org/10.1093/cid/civ482 - DOI - PubMed

Substances

LinkOut - more resources