title: [Evidence and recommendation of empirical antimicrobial treatment in pyogenic spondylodiscitis: systematic review].
abstract: BACKGROUND
  Pyogenic spondylodiscitis is the infectious process that affects the vertebral body and the intervertebral disc. It has an incidence between 2 and 7%. To prescribe antibiotic treatment, it is required to identify the causative organism on the basis of the epidemiology of the etiologic agent, as well as the ability of the antibiotic to penetrate the bone tissue and the intervertebral disc. The objective was to identify the level of evidence and the grade of recommendation for the empiric initial treatment.
  
  
  METHODS
  A systematic review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria. PubMed articles were evaluated to assess their level of evidence and the grade of recommendation according to the Jadad scale and the classification of Sackett. On the basis of those two scales, it was analyzed the agreement by two observers and a Kappa value of 0.750 (p = 0.0001) was considered statistically significant.
  
  
  RESULTS
  642 studies were analyzed, out of which only 19 met the inclusion criteria. In these it was identified a level of evidence 4 and a degree of recommendation C for the use of fluoroquinolones in association with rifampicin in the empirical treatment of pyogenic spondylodiscitis and the use of vancomycin for the treatment of methicillin-resistant strains.
  
  
  CONCLUSIONS
  There is not enough information concerning the use of empiric antibiotics in pyogenic spondylodiscitis; however, the existing information is favorable, even though it is not conclusive.
authors.affiliation: Departamento Clínico de Columna, Hospital de Ortopedia, Unidad Médica de Alta Especialidad "Victorio de la Fuente Narváez", Instituto Mexicano del Seguro Social, Ciudad de México. jose.perezata@imss.gob.mx.
authors.forename: David Agustín
authors.initials: DA
authors.lastname: Cordero-Delgado
authors.forename: Alfredo Javier
authors.initials: AJ
authors.lastname: Moheno-Gallardo
authors.forename: Rubén
authors.initials: R
authors.lastname: Torres-González
authors.forename: Argenis
authors.initials: A
authors.lastname: Mata-Hernández
authors.forename: Eulalio
authors.initials: E
authors.lastname: Elizalde-Martínez
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Pérez-Atanasio
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015299:Discitis / Q000175:diagnosis / Q000188:drug therapy*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Discitis; Low back pain; Spine; Systematic review