INTRODUCTION: Medical management of spinal discitis and vertebral osteomyelitis is based on pathogen specific antibiotic therapy. Current guidelines recommend biopsy and culture prior to initiating antibiotics. Our objective was to evaluate whether current treatment guidelines are being followed.
METHODS: We retrospectively reviewed the hospital records at our institution from 2002‐2007 of all patients admitted with the diagnosis of discitis or vertebral osteomyelitis (ICD‐9 722.90 ‐ 722.93). Exclusion criteria included patients with a spinal fluid collection causing symptomatic neurologic compression and patients with bacteremic sepsis.
RESULTS: 39 patients (59 years, 22 Male/ 17 Female) were reviewed. Risk factors were identified in 30 patients (79%), most commonly: diabetes (38%), IVDA (20%), and ESRD (13%). The mean duration of symptoms prior to admission was 27 days (range, 3‐120 days). Infection was localized to the cervical (13%), thoracic (15%), and lumbar/sacral regions (72%). Antibiotics were started a mean of 27 hours (range, 0‐198 hours) after admission. 14 patients (36%) received antibiotics within 4 hours of admission and 13 patients (33%) received antibiotics prior to obtaining a diagnostic spinal MRI. Biopsy and culture was performed in 20 patients (51%) with 11 (55%) performed after antibiotic administration. Biopsies were not performed in 19 patients (49%), with 14 biopsies not performed secondary to the prior initiation of antibiotics. Overall, 25 patients (64%) were not treated according to treatment guidelines. Specific bacterial pathogens were cultured in 9 biopsies (45%), of which 6 (67%) had antibiotics held until biopsy completion. Biopsies performed after antibiotics identified pathogens in only 3 (27%).
DISCUSSION: 25 patients (64 %) treated at our institution for spinal discitis and vertebral osteomyelitis were not treated according to recommended guidelines. Surprisingly, 13 patients (33%) received empiric antibiotics secondary to fever and spine pain without a confirmatory diagnosis of spinal infection. Physician education is imperative regarding the proper management of this disease.