title: In vitro assessment of the antibiotic efficacy of contrast media and antibiotics and their combinations at various dilutions.
abstract: Discography is a controversial diagnostic procedure involving the injection of radiographic contrast medium (RCM) into the intervertebral disc. Iatrogenic bacterial discitis is a rare but serious complication. The intervention has been increasingly performed in our patients here in the United Arab Emirates. Prophylactic intravenous antibiotic administration can reduce post-interventional discitis; however, this may favour the development of bacterial resistance. Direct intradiscal injection of an antibiotic together with the RCM is a potential alternative. To date, there has been only one study on the efficacy of antibiotics added to an RCM. Equally, there are only limited data regarding the potential direct effect of RCM on bacterial growth. The purpose of this study was to determine whether the efficacy of antibiotics is affected when RCM are added. In an in vitro study, the effect of non-ionic RCM on the growth of five laboratory bacterial strains, alone and in combination with three broad-spectrum antimicrobials, was tested. Bacterial growth was assessed in the absence and the presence of RCM, antibiotics and their combinations. All three RCM alone demonstrated some inhibition of bacterial growth at high concentrations. In the presence of the RCM, all three antibiotics retained their inhibitory effect on bacterial growth. In conclusion, our in vitro experiments did not reveal any changes in the antimicrobial efficacy of the three antibiotics in the presence of the three tested RCM. Subsequent clinical trials will need to assess whether intradiscal antibiotic administration may be a suitable substitute for, or a supplement to, prophylactic systemic antibiotics before discography.
authors.affiliation: Department of Radiology, United Arab Emirates University, UAE.
authors.forename: R D
authors.initials: RD
authors.lastname: Langer
authors.forename: A
authors.initials: A
authors.lastname: Usmani
authors.forename: K N
authors.initials: KN
authors.lastname: van Gorkom
authors.forename: D E
authors.initials: DE
authors.lastname: Lorke
authors.forename: G
authors.initials: G
authors.lastname: Petroianu
authors.forename: S
authors.initials: S
authors.lastname: Azimullah
authors.forename: S M
authors.initials: SM
authors.lastname: Nurulain
mesh_terms: D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001424:Bacterial Infections / Q000517:prevention & control; D002443:Ceftriaxone / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage*; D015299:Discitis / Q000382:microbiology / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004926:Escherichia coli / Q000187:drug effects; D005839:Gentamicins / Q000008:administration & dosage; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006094:Gram-Positive Bacteria / Q000187:drug effects; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging*; D007711:Klebsiella pneumoniae / Q000187:drug effects; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D011859:Radiography; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D013211:Staphylococcus aureus / Q000187:drug effects; D013212:Staphylococcus epidermidis / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D003287:Contrast Media; D005839:Gentamicins; D019275:Radiopharmaceuticals; D002443:Ceftriaxone; D000667:Ampicillin
references.citation: Spine (Phila Pa 1976). 1995 Mar 15;20(6):685-8
references.pmid: 7604344
references.citation: Acta Orthop Scand. 1948;17(3-4):231-9
references.pmid: 18879767
references.citation: Invest Radiol. 1982 May-Jun;17(3):305-9
references.pmid: 7118519
references.citation: J Bone Joint Surg Br. 1987 Jan;69(1):26-35
references.pmid: 3818728
references.citation: Eur Spine J. 1998;7(1):36-9
references.pmid: 9548356
references.citation: Spine (Phila Pa 1976). 1989 Sep;14(9):1025-32
references.pmid: 2781408
references.citation: Spine J. 2003 May-Jun;3(3 Suppl):11S-27S
references.pmid: 14589214
references.citation: Eur J Radiol. 2005 Jun;54(3):431-7
references.pmid: 15899347
references.citation: Reg Anesth Pain Med. 2005 Mar-Apr;30(2):163-83
references.pmid: 15765459
references.citation: Spine (Phila Pa 1976). 2006 Feb 15;31(4):391-6
references.pmid: 16481948
references.citation: Eur Spine J. 2006 May;15(5):620-6
references.pmid: 16292635
references.citation: Spine (Phila Pa 1976). 1996 May 15;21(10):1274-6
references.pmid: 8727202
references.citation: J Bone Joint Surg Br. 1990 Mar;72(2):271-4
references.pmid: 2312567
references.citation: Semin Ultrasound CT MR. 2005 Apr;26(2):81-8
references.pmid: 15856809
references.citation: Spine (Phila Pa 1976). 2006 Mar 1;31(5):567-70
references.pmid: 16508553
references.citation: Spine (Phila Pa 1976). 2005 Nov 1;30(21):2369-77; discussion 2378
references.pmid: 16261111
references.citation: Australas Radiol. 1995 Feb;39(1):10-3
references.pmid: 7695517
references.citation: Br J Radiol. 1983 Nov;56(671):809-15
references.pmid: 6354344
references.citation: Pain Med. 2005 May-Jun;6(3):213-21; discussion 222-4
references.pmid: 15972084
references.citation: Spine (Phila Pa 1976). 2006 Aug 15;31(18):2115-23
references.pmid: 16915099
references.citation: Pain Physician. 2008 Jul-Aug;11(4):513-38
references.pmid: 18690280
references.citation: AJNR Am J Neuroradiol. 2006 Oct;27(9):1930-2
references.pmid: 17032869
references.citation: J Spinal Disord Tech. 2004 Jun;17(3):243-7
references.pmid: 15167342
references.citation: Eur Spine J. 2006 Sep;15(9):1397-403
references.pmid: 16830132
references.citation: Spine J. 2002 Jan-Feb;2(1):25-34
references.pmid: 14588285
references.citation: Spine (Phila Pa 1976). 1992 Mar;17(3):356-8
references.pmid: 1566171
references.citation: Spine (Phila Pa 1976). 2003 Aug 1;28(15):1735-8
references.pmid: 12897501
references.citation: Spine (Phila Pa 1976). 1995 Sep 15;20(18):2048-59
references.pmid: 8578384
references.citation: Spine (Phila Pa 1976). 2004 Dec 1;29(23):E542-6
references.pmid: 15564903
references.citation: Radiol Clin North Am. 1998 May;36(3):463-95
references.pmid: 9597067