Antibiotikatherapie der pyogenen Spondylodiszitis bei Erwachsenen

Zusammenfassung

Für eine erfolgreiche Behandlung der pyogenen Spondylodiszitis ist eine suffiziente Antibiotikatherapie essenziell. Bei hämodynamisch stabilen Patienten mit normalem neurologischem Status sollte mit einer Antibiotikatherapie solange gewartet werden, bis die mikrobiologische Diagnostik einen Erregernachweis mit Antibiogramm erbringt und somit eine gezielte Therapie ermöglicht. Bei hämodynamisch instabilen Patienten oder bei Patienten mit fortschreitenden bzw. schweren neurologischen Symptomen sollte vor der kalkulierten Therapie eine mikrobiologische Diagnostik (Blutkulturen) eingeleitet werden. Empfehlungen zur kalkulierten und gezielten Therapie der pyogenen Spondylodiszitis sind in dieser Arbeit formuliert. In unkomplizierten Verläufen, ohne operative Instrumentation, ist eine systemische Therapiedauer von 6 Wochen ausreichend. Im Rahmen einer operativen Sanierung des Infektherdes stehen lokale Antibiotikaträger auf der Basis von Hydroxylapatit und Kalziumsulfat zur Verfügung.

Abstract

For a successful treatment of pyogenic spondylodiscitis, sufficient antibiotic therapy is essential. In cases with hemodynamically stable patients with normal neurological status, an antibiotic treatment should be withheld until microbiological diagnostics provide antibiotic detection and thus allow adequate therapy. In hemodynamically unstable situations or in patients with progressive or severe neurological symptoms microbiological diagnostics (blood cultures) should be initiated before the calculated therapy is started. Recommendations on the calculated and targeted therapy of pyogenic spondylodiscitis are formulated in this work. In uncomplicated courses, without an instrumentation, a systemic therapy duration of 6 weeks is sufficient. Local antibiotics basing on hydroxylapatite and calcium sulfate are available as part of an surgical sanitation of the infective focus.

Schlüsselwörter

Spondylodiszitis - Antibiotika - Mikrobiologie - lokale Antibiotikatherapie - systemische Antibiotikatherapie

Keywords

spondylodiscitis - antibiotics - microbiology - local antibiotic treatment - systemic antibiotic treatment

• Literatur

• 1 Cottle L, Riordan T. Infectious spondylodiscitis. J Infect 2008; 56: 401-412
• 2 Mete B, Kurt C, Yilmaz MH. et al. Vertebral osteomyelitis: eight years experience of 100 cases. Rheumatol Int 2011; 32: 3591-3597
• 3 Hadjipavlou AG, Mader JT, Nessessary JT. et al. Haematogenous pyogenic spinal infections and theis surgical management. Spine 2000; 25: 1668-1679
• 4 Murillo O, Grau I, Lora-Tamayo J. et al. The changing epidemiology of bacteraemic osteoarticular infections in the early 21st century. Clin Microbiol Infect. 2015; 21: 254.e1-e8
• 5 Kim J, Kim YS, Peck KR. et al. Outcome of culture-negative pyogenic vertebral osteomyelitis: comparison with microbiologically confirmed pyogenic vertebral osteomyelitis. Semin Arthritis Rheum 2014; 44: 246-252
• 6 Sakkas LI, Davas EM, Kapsalaki E. Hematogenous spinal infection in central Greece. Spine (Phila Pa 1976) 2009; 34: E513-E518
• 7 Kim CJ, Song KH, Jeon JH. A comparative study of pyogenic and tuberculous spondylodiscitis. Spine (Phila Pa 1976) 2010; 35: E1096
• 8 Mylona E, Samarkos M, Kakalou E. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum 2009; 39: 10-7
• 9 D’Agostino C, Scorzolini L, Massetti AP. A sevenyear prospective study on spondylodiscitis: epidemiological and microbiological features. Infection 2010; 38: 102-107
• 10 Gardos F, Lescure FX, Senneville E. et al. Suggestions for managing pyogenic (non-tuberculous) discitis in adults. Joint Bone Spine 2007; 74: 133-139
• 11 Nourbakhsh A, Grady JJ, Garges KJ. Percutaneous spine biopsy: a meta-analysis. J Bone Joint Surg Am 2008; 90: 1722-1725 49.
• 12 Lora-Tamayo J, Euba G, Narvaez JA. Changing trends in the epidemiology of pyogenic vertebral osteomyelitis: the impact of cases with no microbiologic diagnosis. Semin Arthritis Rheum 2011; 41: 247-255
• 13 Cebrian JL, Saez-Arenillas Martin A, Urda Martinez-Aedo AL. Management of infectious discitis. Outcome in one hundred and eight patients in a university hospital. Int Orthop 2012; 36: 239-244
• 14 Lehner B, Akbar M, Rehnitz C. et al. Standards of microbiological diagnostics of spondylodiscitis. Orthopäde 2012; 41: 702-710
• 15 Societe de Pathologie Infectieuse de Langue Francaise ( SPILF ). Recommandations pour la pratique Clinique, Spondylodiscites infectieuses primitives, et secondaires a un geste intra-discal, sans mise en place de materiel. Med. Mal Infect 2007; 37: 554-572
• 16 Shibayama M, Nagahara M, Kawase G. New needle biopsy technique for lumbar pyogenic spondylodiscitis. Spine (Phila Pa 1976) 2010; 35: E1347-E1349
• 17 Gras G, Buzele R, Parienti JJ. Microbiological diagnosis of vertebral osteomyelitis: relevance of second percutaneous biopsy following initial negative biopsy and limited yield of post-biopsy blood cultures. Eur J Clin Microbiol Infect Dis 2014; 33: 371-375
• 18 Müller-Broich JD, Petersdorf S, Pfugmacher R. Implementation of a diagnostic-algorhythm in the treatment of unspecific spondylodiszitis – save tool for pathogen detection. Eur Spine J 2011; 20: 1979-2066
• 19 Marschall J, Bhavan KP, Olsen MA. The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis. Clin Infect Dis 2011; 52: 867-872
• 20 de Lucas EM, Gonzalez MandlyA, Gutierrez A. CT-guided fine-needle aspiration in vertebral osteomyelitis: true usefulness of a common practice. Clin Rheumatol 2009; 28: 315-320
• 21 Kim CJ, Song KH, Park WB. Microbiologically and clinically diagnosed vertebral osteomyelitis: impact of prior antibiotic exposure. Antimicrob Agents Chemother 2012; 56: 2122-2124
• 22 Nickerson EK, Sinha R. Vertebral osteomyelitisin adults: an update. British medical bulletin 2016; 117: 121-138
• 23 Rutges JP, Kempen DH, van Dijk M. et al. Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review. Eur Spine J Apr 2016; 25: 983-999
• 24 Landersdorfer CB, Bulitta JB, Kinzig M. et al. Penetration of antibacterials into bone: pharmacokinetic, pharmacodynamic and bioanalytical considerations. Clin.Pharmacokinet 2009; 48: 89-124
• 25 Berbari EF, Kanj SS, Kowalski TJ. et al. Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin.Infect Dis 2015; 61: 859-863
• 26 Ascione T, Balato G, DiDonato SL. et al. ( 2017) Clinical and microbiological outcomes in haematogenous spondylodiscitis treated conservatively. Eur Spine J 2017;
• 27 Rangaraj G, Cleveland KO, Gelfand MS. Comparative analysis of daptomycin and vancomycin in the treatment of vertebral osteomyelitis. Infect Dis Clin Pract 2014; 22: 219-222
• 28 Hagiya H, Haruki Y, Uchida T. et al. Emergence of Daptomycin-Resistant Staphylococcus aureus during treatment. Intern Med 2016; 55: 73-78
• 29 Lefebvre M, Jacqueline C, Amador G. et al. Efficacy of daptomycin combined with rifampicin for the treatment of experimental methicillin-resistant Staphylococcus aureus (MRSA) acute osteomyelitis. Int J Antimicrob Agents 2010; 36: 542-544
• 30 Graninger W, Leitha T, Breyer S. et al. Methicillin- and gentamicin-resistant Staphylococcus aureus: susceptibility to fosfomycin, cefamandole, N-formimidoyl-thienamycin, clindamycin, fusidic acid and vancomycin. Drugs Exp Clin Res 1985; 11: 23-27
• 31 Fachinformation InfectoFos.
• 32 Lee WS, Chen YC, Chen HP. et al. Vertebral osteomyelitis caused by vancomycin-tolerant methicillin-resistant Staphylococcus aureus bacteremia: Experience with teicoplanin plus fosfomycin combination therapy. J Micobiol Immunol Infect 2016; 49: 600-603
• 33 Moenster RP, Linneman TW, Call WB. The potential role of newer gram-positive antibiotics in the setting of osteomyelitis of adults. J Clin Pharm Ther 2013; 38: 89-96
• 34 Hopkinson N, Stevenson J, Benjamin S. A case ascertainment study of septic discitis: clinical, microbiological and radiological features. Q J Med 2001; 94: 465-470
• 35 Zimmerli W. Vertebral Osteomyelitis. N Eng J Med 2010; 362: 1022-1029
• 36 McHenry MC, Easley KA, Locker GA. (2002) Verebral osteomyelitis: long term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 2002; 34: 1342-1350
• 37 Friedman JA, Maher CO, Quast LM. et al. Spontaneous disc space infections in adults. Surg. Neurol 2002; 57: 81-86
• 38 Jensen AG, Espersen F, Skinhoj P. Bacteremic Staphylococcus aureus spondylitis. Arch Intern Med 1998; 158: 509-517
• 39 Sobottke R. Aktuelle Diagnostik und Therapie der Spondylodiszitis. Dtsch Ärtzebl. 2008; 105: 181-187
• 40 Bernard L, Dinh A, Ghout I. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet 2014; 385: 875-882
• 41 Roblot F, Besnier JM, Juhel L. et al. Optimal duration of antibiotic therapy in vertebral osteomyelitis. Semin Arthritis Rheum 2007; 36: 269-277
• 42 Park KH, Chong YP, Kim SH. Clinical characteristics and therapeutic outcomes of hematogenous vertebral osteomyelitis caused by methicillin-resistant Staphylococcus aureus. J Infect 2013; 67: 556-564
• 43 Govender S. Spinal infections. J Bone Joint Surg Br 2005; 87: 1454-1458
• 44 Klemm R, Schnettler R. Gentamycin-PMMA-Ketten Chirurgische Infektionen von Knochen, Gelenken und Weichteilen. Berlin-New-York: Schultheis, Rehm und Ecke, de-Gruyter-Verlag; 1991: 45-47
• 45 Mehta S, Humphrey JS, Schenkman DI. et al. Gentamicin distribution from collagen carrier. J Orthop Res 1996; 14: 749-754
• 46 Ascherl R, Sternberg A, Lechner F. et al. Local treatment of infection with collagen gentamicin. Aktuelle Probl Chir Orthop 1990; 34: 85-93
• 47 Rauschmann MA, Wichelhaus TA, Stirnal V. et al. Nanocrystalline hydroxyapatite and calcium sulphate as biodegradable composite carrier material for local delivery of antibiotics in bone infections. Biomaterials 2005; 26: 2677-2684
• 48 Bostemann R, Steiger Jh, Scholz AO. First report on treating spontaneous infectious spondylodiscitis of lumbar spine with posterior debridement, posterior instrumentation and an injectable calcium sulfate/hydroxyapatite composite eluting gentamicin: a case report. J Med Case Rep 2016; 12;10: 349
• 49 Winkler H, Janata O, Berger C. et al. In vitro release of vancomycin and tobramycin from impregnated human and bovine bone grafts. J Antimicrob Chemother 2000; 423-428
• 50 Mayberry-Carson KJ, Tober-Meyer B, Smith JK. et al. Bacterial adherence and glycocalyx formation in osteomyelitis experimentally induced with staphylococcus aureus. Infection and Immunity 1984; 43: 825-833
• 51 Walenkamp GH, Vree TOMB, Van Rens TJ. Gentamicin-PMMA beads: Pharmacokinetic and nephrotoxicological study. Clinical Orthopaedics & Related Research 1986; 205: 171-183
• 52 Chang W, Colangeli M, Colangeli S. et al. Adult osteomyelitis: Debridement versus debridement plus osteoset T^® pellets. Acta Orthopaedica Belgica 2007; 73: 238-244
• 53 Stewart PS, Costerton JW. Antibiotic resistance of bacteria in biofilms. The Lancet (9276) 2001; 358: 135-138
• 54 Buser Z, Brodke DS, Youssef JA. et al. Synthetic bone graft versus autograft or allograft for spinal fusion: a systematic review. J Neurosurg Spine 2016; 25: 509-516
• 55 Jamali A, Hilpert A, Debes J. et al. Hydroxyapatite/carbonate (HA/CC) vs. Plaster of Paris: a histomorphometric and radiographic study in a rabbit tibial defect model. Calcif Tissue Int 2002; 71: 172-178
• 56 Rathbone CR, Cross JD, Brown KV. et al. Effect of various concentrations of antibiotics on osteogenic cell viability and activity. Journal of Orthopaedic Research 2011; 29: 1070-1074
• 57 Eder C, Schenk S, Trifinopoulos J. et al. Does intrawound application of vancomycin influence bone healing in spinal surgery?. Eur Spine 2016; 25: 1021-1028
• 58 Goldschmidt E, Rasmussen J, Chabot JD. et al. The effect of vancomycin powder on human dural fibroblast culture and its implications for dural repair during spine surgery. J Neurosurg Spine 2016; 25: 665-670
• 59 Mendoza MC, Sonn KA, Kannan AS. et al. The effect of vancomycin powder on bone healing in a rat spinal rh BMP-2 model. J Neurosurg Spine 2016; 25: 147-153
• 60 von Stechow D, Rauschmann M. Effectiveness of Combination Use of Antibiotic-Loaded PerOssal with Spinal Surgery in Patients with Spondylodiscitis. Eur Surg Res 2009; 43: 298-305
• 61 Tuchscherr L, Kreis CA, Hoerr V. et al. Staphylococcus aureus develops increased resistance to antibiotics by forming dynamic small colony variants during chronic osteomyelitis. J Antimicrob Chemother 2016; 71: 438-448
• 62 Proctor RA, Kahl B, von Eiff C. et al. Staphylococcal small colony variants have novel mechanisms for antibiotic resistance. Clin Infect Dis 1998; 27 (Suppl. 01) 68-74
• 63 Lenhard JR, von Eiff C, Hong IS. et al. Evolution of Staphylococcus aureus under vancomycin selective pressure: the role of the small-colony variant phenotype. Antimicrob Agents Chemother 2015; 59: 1347-1351
• 64 Baquero F, Negri M, Morosini M. et al. Selection of very small differences in bacterial evolution. International Microbiology 1998; 1: 295-300