title: Spondylodiscitis: update on diagnosis and management.
abstract: Spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, is the main manifestation of haematogenous osteomyelitis in patients aged over 50 years. Staphylococcus aureus is the predominant pathogen, accounting for about half of non-tuberculous cases. Diagnosis is difficult and often delayed or missed due to the rarity of the disease and the high frequency of low back pain in the general population. In this review of the published literature, we found no randomized trials on treatment and studies were too heterogeneous to allow comparison. Improvements in surgical and radiological techniques and the discovery of antimicrobial therapy have transformed the outlook for patients with this condition, but morbidity remains significant. Randomized trials are needed to assess optimal treatment duration, route of administration, and the role of combination therapy and newer agents.
authors.affiliation: Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge CB2 0QW, UK. theodore.gouliouris@addenbrookes.nhs.uk
authors.forename: Theodore
authors.initials: T
authors.lastname: Gouliouris
authors.forename: Sani H
authors.initials: SH
authors.lastname: Aliyu
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Brown
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D001842:Bone and Bones / Q000000981:diagnostic imaging; D015299:Discitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D013211:Staphylococcus aureus / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents