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

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY European Spine Journal Pub Date : 2024-10-17 DOI:10.1007/s00586-024-08526-w

Hisanori Gamada, Toru Funayama, Yosuke Ogata, Takane Nakagawa, Takahiro Sunami, Kotaro Sakashita, Shun Okuwaki, Kaishi Ogawa, Yosuke Shibao, Hiroshi Kumagai, Katsuya Nagashima, Kengo Fujii, Yosuke Takeuchi, Masaki Tatsumura, Itsuo Shiina, Masafumi Uesugi, Masao Koda

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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.

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采用微创后固定术治疗胸腰椎化脓性脊柱炎时，延长抗生素疗程的因素和早期手术的影响。

目的：化脓性脊柱炎建议使用 6-12 周的标准抗生素疗程。最近的证据支持早期微创后固定手术，但其对抗生素治疗持续时间的影响尚不明确。本研究旨在确定对保守治疗耐药的胸腰椎化脓性脊柱炎患者延长抗生素治疗时间的相关因素，并评估早期手术是否能缩短治疗时间：我们回顾性研究了在九家医疗机构接受微创后路固定术的74例胸腰椎化脓性脊柱炎患者。根据抗生素持续时间（开始使用抗生素≥6周或3周）对患者进行分组。采用单变量和多变量逻辑回归分析确定与抗生素治疗时间过长相关的因素，并研究接受早期手术患者的预后：49名患者（66%）需要长期抗生素治疗。髂腰肌脓肿（p = 0.0006）和 C 反应蛋白（CRP）水平升高（≥ 10 mg/dL，p = 0.015）与抗生素治疗时间延长密切相关。早期手术大大缩短了抗生素治疗的总时间（5.3 周 vs. 9.9 周，p 结论：早期手术（三周内）是延长抗生素治疗时间的关键因素：无论是否存在髂腰肌脓肿和 CRP 水平升高等延长治疗时间的因素，胸腰椎化脓性脊柱炎的微创后固定早期手术（三周内）与抗生素治疗时间和总治疗时间的缩短有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Spine Journal 医学-临床神经学

CiteScore

4.80

自引率

10.70%

发文量

373

审稿时长

2-4 weeks

期刊介绍： "European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts. Official publication of EUROSPINE, The Spine Society of Europe