Prost Max, Röckner Melanie Elisabeth, Vasconcelos Malte Kohns, Windolf Joachim, Konieczny Markus Rafael
Department of Orthopedic and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
Department of Orthopedic and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany.
Int J Spine Surg. 2023 Aug;17(4):607-614. doi: 10.14444/8482. Epub 2023 Jul 17.
Antibiotic treatment of spondylodiscitis is influenced by antibiotic stewardship; specifically, empirical antibiotic therapy is avoided in favor of-delayed-targeted antibiotic therapy after microbiological diagnosis. Only patients with neurological deficits or clinical signs of sepsis should be treated by empirical antibiotic therapy. However, the level of evidence for this treatment concept is weak.
The aim of this study was to investigate whether patients who were treated with a nontargeted antibiotic therapy show a worse outcome than patients who were exclusively treated with targeted antibiotic therapy.
STUDY DESIGN/SETTING: A retrospective single-center data analysis.
We included 201 patients with spondylodiscitis who were treated at the authors' institution between 2013 and 2020.
Mortality rate, time in hospital, development of laboratory parameters, and development of pain (visual analog scale).
We performed a retrospective data analysis of patients who were treated for spondylodiscitis from January 2013 to March 2020. Clinical and demographic data as well as outcome and complications were recorded and analyzed. We investigated whether patients who were treated by a nontargeted antibiotic therapy had a worse outcome than patients who were exclusively treated by targeted antibiotic therapy and which other clinical factors had an impact on clinical outcome.
A total of 201 patients were included, 37 of whom developed sepsis during their hospital stay, and 14 of these 37 patients died. The 14 patients who died represented (10.0%) of the subgroup who received an empirical antibiotic treatment before the targeted antibiotic therapy ( = 141). There were 0 deaths in the subgroup who did not receive an empirical antibiotic treatment ( < 0.05). The time to diagnosis since admission to the hospital was 10.5 (2.2) days in patients with sepsis; in patients without sepsis, it was 5.2 (0.9) days ( < 0.05).
Based on the results of this investigation, the authors recommend delaying antibiotic therapy until targeted antibiotic therapy is possible. Furthermore, early diagnosis of spondylodiscitis and prevention and early detection of sepsis are essential to reduce the mortality rate of patients with spondylodiscitis.
脊柱椎间盘炎的抗生素治疗受抗生素管理的影响；具体而言，避免经验性抗生素治疗，倾向于微生物学诊断后的延迟靶向抗生素治疗。只有出现神经功能缺损或脓毒症临床体征的患者才应接受经验性抗生素治疗。然而，这一治疗理念的证据水平较弱。
本研究的目的是调查接受非靶向抗生素治疗的患者是否比仅接受靶向抗生素治疗的患者预后更差。
研究设计/设置：一项回顾性单中心数据分析。
我们纳入了2013年至2020年期间在作者所在机构接受治疗的201例脊柱椎间盘炎患者。
死亡率、住院时间、实验室参数变化以及疼痛程度（视觉模拟评分）。
我们对2013年1月至2020年3月期间接受脊柱椎间盘炎治疗的患者进行了回顾性数据分析。记录并分析临床和人口统计学数据以及结局和并发症。我们调查了接受非靶向抗生素治疗的患者是否比仅接受靶向抗生素治疗的患者预后更差，以及其他哪些临床因素对临床结局有影响。
共纳入201例患者，其中37例在住院期间发生脓毒症，这37例患者中有14例死亡。死亡的14例患者占在靶向抗生素治疗前接受经验性抗生素治疗的亚组的10.0%（n = 141）。未接受经验性抗生素治疗的亚组中无死亡病例（P < 0.05）。发生脓毒症的患者从入院到诊断的时间为10.5（2.2）天；未发生脓毒症的患者为5.2（0.9）天（P < 0.05）。
基于本研究结果，作者建议延迟抗生素治疗，直到能够进行靶向抗生素治疗。此外，脊柱椎间盘炎的早期诊断以及脓毒症的预防和早期发现对于降低脊柱椎间盘炎患者的死亡率至关重要。
