The typical clinical features of discitis include:
- Back or neck pain (>90%)
- Pain often awakes patient from sleep
- Fever (60-70%)
- Neurological deficits (up to 50%)
- Children sometimes refuse to walk
Risk factors for developing discitis include:
- Spinal surgery (occurs in 1-2% post-operatively)
- Intravenous drug use
- Age less than 8 years
- Diabetes mellitus
The most common causative organism is usually Staphylococcus aureus.
Other organisms, such as Streptococcus viridans and Pseudomonas aeruginosa, may also occur in intravenous drug users and the immunocompromised and should be considered as a possible cause.
Other possible organisms include Gram-negative organisms such as Escherichia coli, and Mycobacterium tuberculosis (Pott’s disease).
Plain radiographs are insensitive to the early changes of discitis, and normal appearances can be maintained for 2-4 weeks. CT scanning is also relatively insensitive.
Treatment is with admission for intravenous antibiotics. Three sets of blood cultures, as well as a full set of bloods including a CRP, should be sent to the lab prior to commencing the antibiotics.
A typical antibiotic regime for discitis would be:
- IV flucloxacillin 2 g 6 hourly 1st line if no penicillin allergy
- IV vancomycin if hospital acquired infection, high-risk of MRSA or documented pencillin allergy
- +/- gentamicin IV if possibility of Gram negative infection (age >65, immunosuppressed or intravenous drug user)
- IV piperacillin-tazobactam 4.5 g 8 hourly alone if acute kidney injury and Gram-negative cover required
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