Intervertebral disc penetration by antibiotics used prophylactically in spinal surgery: implications for the current standards and treatment of disc infections

European spine journal

article

Manu N. Capoor¹  Jan Lochman³  Andrew McDowell⁴  Jonathan E. Schmitz⁵  Martin Solansky³  Martina Zapletalova³  Todd F. Alamin⁶  Michael F. Coscia⁷  Steven R. Garfin⁸  Radim Jancalek⁹  Filip Ruzicka^1,10  A. Nick Shamie^1,11  Martin Smrcka^1,12  Jeffrey C. Wang^1,13  Christof Birkenmaier^1,14  Ondrej Slaby² 

[1]Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University

[2]Central European Institute of Technology (CEITEC), Masaryk University

[3]Department of Biochemistry, Faculty of Science, Masaryk University

[4]Northern Ireland Centre for Stratified Medicine, School of Biomedical Sciences, Ulster University

[5]Department of Pathology, Vanderbilt University School of Medicine

[6]Department of Orthopedic Surgery, Stanford University Medical Center, Stanford University

[7]Department of Orthopedic Surgery, OrthoIndy Hospital

[8]Department of Orthopaedic Surgery, University of California San Diego

[9]Department of Neurosurgery, Masaryk University, St. Anne’s University Hospital

[10]Department of Microbiology, Masaryk University, St. Anne’s University Hospital

[11]Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California

[12]Department of Neurosurgery, University Hospital Brno, Masaryk University

[13]Department of Orthopedic Surgery, University Southern California

[14]Department of Orthopedics, Physical Medicine and Rehabilitation, University of Munich (LMU)

关键词: Propionibacterium acnes;    Cutibacterium acnes;    Degenerative disc disease;    Bioflm;    Cefazolin;    Clindamycin;    Vancomycin;    Surgical prophylaxis;   

DOI  :  10.1007/s00586-018-5838-z

来源: Springer

【 摘 要 】

The presence of Propionibacterium acnes in a substantial component of resected disc specimens obtained from patients undergoing discectomy or microdiscectomy has led to the suggestion that this prominent human skin and oral commensal may exacerbate the pathology of degenerative disc disease. This hypothesis, therefore, raises the exciting possibility that antibiotics could play an important role in treating this debilitating condition. To date, however, little information about antibiotic penetration into the intervertebral disc is available. Intervertebral disc tissue obtained from 54 microdiscectomy patients given prophylactic cefazolin (n = 25), clindamycin (n = 17) or vancomycin (n = 12) was assayed by high-performance liquid chromatography, with cefaclor as an internal standard, to determine the concentration of antibiotic penetrating into the disc tissue. Intervertebral disc tissues from patients receiving the positively charged antibiotic clindamycin contained a significantly greater percentage of the antibacterial dose than the tissue from patients receiving negatively charged cefazolin (P < 0.0001) and vancomycin, which has a slight positive charge (P < 0.0001). Positively charged antibiotics appear more appropriate for future studies investigating potential options for the treatment of low-virulence disc infections. These slides can be retrieved under Electronic Supplementary Material.

【 授权许可】

Unknown