Abstract
Aim
The purpose of our study was to see what the microbiological epidemiology of our discitis biopsy specimens were. In doing this we could identify if biopsy served a strategic and necessary purpose in the management of this potentially serious pathology.
Methods
At our institution the Combined Orthopaedic and Medical Microbiology Service (COMMS) reviews all patients on antibiotic treatment on a weekly basis and records data prospectively. We present a review of discitis patient data from a 28 month period (August 2008-December 2010). Inclusion criteria included a first diagnosis of discitis, based on a history of pain, raised inflammatory markers (erythrocyte sedimentation rate, C reactive protein), MRI confirmation, radiological biopsy of disc, patients that had spinal procedures and patients that had no spinal procedures. Exclusion criteria included patients who did not have a disc biopsy or MRI scan diagnosis. The outcome measure was discitis biopsy micro-organism.
Results
Thirty four cases were included, of which 25 cases were biopsy positive for a micro-organism. There were 11 different micro-organisms seen. The 3 most common micro-organisms were staphylococcus aureus, propionibacter acnes and streptococcus.
Conclusion
Radiological disc biopsy reveals variability in micro-organism pathology which will affect antibiotic management, treatment course and prognosis. We recommend radiological disc biopsy at the outset for optimum treatment, from culture sensitive antibiotics. Culture negative biopsies can be treated with consensus based empirical treatment in-line with discitis biopsy epidemiology.
