Manu N Capoor1,2, Jan Lochman3, Andrew McDowell4, Jonathan E Schmitz5, Martin Solansky3, Martina Zapletalova3, Todd F Alamin6, Michael F Coscia7, Steven R Garfin8, Radim Jancalek9, Filip Ruzicka10, A Nick Shamie11, Martin Smrcka12, Jeffrey C Wang13, Christof Birkenmaier14, Ondrej Slaby15. 1. Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, 1230 York Avenue, New York, NY, USA. mcapoor@mail.rockefeller.edu. 2. Central European Institute of Technology (CEITEC), Masaryk University, Kamenice 753/5, 625 00, Brno, Czech Republic. mcapoor@mail.rockefeller.edu. 3. Department of Biochemistry, Faculty of Science, Masaryk University, Brno, Czech Republic. 4. Northern Ireland Centre for Stratified Medicine, School of Biomedical Sciences, Ulster University, Londonderry, UK. 5. Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA. 6. Department of Orthopedic Surgery, Stanford University Medical Center, Stanford University, Stanford, CA, USA. 7. Department of Orthopedic Surgery, OrthoIndy Hospital, Indianapolis, IN, USA. 8. Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA. 9. Department of Neurosurgery, Masaryk University, St. Anne's University Hospital, Brno, Czech Republic. 10. Department of Microbiology, Masaryk University, St. Anne's University Hospital, Brno, Czech Republic. 11. Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. 12. Department of Neurosurgery, University Hospital Brno, Masaryk University, Brno, Czech Republic. 13. Department of Orthopedic Surgery, University Southern California, Los Angeles, CA, USA. 14. Department of Orthopedics, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany. 15. Central European Institute of Technology (CEITEC), Masaryk University, Kamenice 753/5, 625 00, Brno, Czech Republic. ondrej.slaby@ceitec.muni.cz.
Abstract
PURPOSE: The presence of Propionibacterium acnes in a substantial component of resected disc specimens obtained from patients undergoing discectomy or microdiscectomy has led to the suggestion that this prominent human skin and oral commensal may exacerbate the pathology of degenerative disc disease. This hypothesis, therefore, raises the exciting possibility that antibiotics could play an important role in treating this debilitating condition. To date, however, little information about antibiotic penetration into the intervertebral disc is available. METHODS: Intervertebral disc tissue obtained from 54 microdiscectomy patients given prophylactic cefazolin (n = 25), clindamycin (n = 17) or vancomycin (n = 12) was assayed by high-performance liquid chromatography, with cefaclor as an internal standard, to determine the concentration of antibiotic penetrating into the disc tissue. RESULTS: Intervertebral disc tissues from patients receiving the positively charged antibiotic clindamycin contained a significantly greater percentage of the antibacterial dose than the tissue from patients receiving negatively charged cefazolin (P < 0.0001) and vancomycin, which has a slight positive charge (P < 0.0001). CONCLUSION: Positively charged antibiotics appear more appropriate for future studies investigating potential options for the treatment of low-virulence disc infections. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: The presence of Propionibacterium acnes in a substantial component of resected disc specimens obtained from patients undergoing discectomy or microdiscectomy has led to the suggestion that this prominent human skin and oral commensal may exacerbate the pathology of degenerative disc disease. This hypothesis, therefore, raises the exciting possibility that antibiotics could play an important role in treating this debilitating condition. To date, however, little information about antibiotic penetration into the intervertebral disc is available. METHODS: Intervertebral disc tissue obtained from 54 microdiscectomy patients given prophylactic cefazolin (n = 25), clindamycin (n = 17) or vancomycin (n = 12) was assayed by high-performance liquid chromatography, with cefaclor as an internal standard, to determine the concentration of antibiotic penetrating into the disc tissue. RESULTS: Intervertebral disc tissues from patients receiving the positively charged antibiotic clindamycin contained a significantly greater percentage of the antibacterial dose than the tissue from patients receiving negatively charged cefazolin (P < 0.0001) and vancomycin, which has a slight positive charge (P < 0.0001). CONCLUSION: Positively charged antibiotics appear more appropriate for future studies investigating potential options for the treatment of low-virulence disc infections. These slides can be retrieved under Electronic Supplementary Material.
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