Infectious Spondylodiscitis by Uncommon Pathogens: A Pitfall of Empirical Antibiotics

OBJECTIVE The goal of this study is to evaluate the prevalence of spondylodiscitis (SD) caused by uncommon pathogens and review the efficacy of the treatment strategy including the coverage by usual empirical broad-spectrum antibiotic therapy. METHODS Ninety-nine consecutive patients diagnosed and treated for infectious SD between January 2007 to May 2015 were reviewed retrospectively. The prevalence of uncommon SD, predisposing factors, antibiotics sensitivity, and clinical outcome were analyzed in comparison with that of common SD. RESULTS Among 99 patients, 68 patients were culture positive. Out of 68 patients with positive culture results, 54 of them(79.4%) were common pathogen and 14 (20.6%) were uncommon pathogen. Postoperative SDs were significantly prevalent in uncommon SD(42.9%) than common SD(27.8%). Recurrence rate was higher in uncommon pathogen SD(14.3%) than common SD group (2.3%), and it showed statistically significant difference (p=0.025). Empirical antibiotics of vancomycin and 3rd or 4th generation cephalosporin covered 100% of nontuberculous common SD and 14.3% of uncommon SD. CONCLUSION In our study, the prevalence of uncommon SD was relatively high uncommon (20.5% of culture positive SD and 14.1% of total cases) and the coverage rate of empirical antibiotics for them were only 14.3%. In particular, the possibility of SD with fun gal, polymicrobial, or multiple drug resistant organism should be considered in SD unresponsive to broad spectrum antibiotics therapy.