DÄ internationalArchive12/2018Questions upon Questions
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As a primary care internist and a trauma surgery layperson, I still am left with numerous clarifying questions.

The authors mentioned (on page 876, at the bottom left) results from Sobottke et al., that spondylodiscitis occurs in 22.2% of patients after conservative treatment, and in 50.4% after invasive treatments, such as catheterization (urinary?) or fine-needle aspiration puncture (where was the puncture made?). However, if correct, this would signify that the absolute number of disease cases is exorbitantly high and not 30 per 250 000 per year, as initially mentioned in the summary (1).

These figures would be meaningful if the text should be inversed: that is, if 22.2% of patients with spondylodiscitis previously underwent conservative treatment, and 50.4%, invasive treatments (such as catheterization or puncture). Would this still be considered hematogenic, which according to the introduction should be the most common pathway of infection? Indeed, how do exogenous, endogenous, and hematogenous infections differ? Take as an example a case of spondylodiscitis following thyroid gland puncture. As a layperson, I would say that it is an exogenous form, as germs are introduced from the outside „exogenously“; however, as the germs are carried through the bloodstream, is it therefore „hematogenic“?

Furthermore, I would have liked a more detailed antibiotic recommendation with dosages, which is after all relevant to everyday life, especially in cases of intolerance or allergy to a previous medication and the antibiotic used as an alternative.

DOI: 10.3238/arztebl.2018.0210a

Dr. med. Cornel Certain

Konstanz, dr.cornel-certain@web.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Herren C, Jung N, Pishnamaz M, Breuninger M, Siewe J, Sobottke R: Spondylodiscitis: diagnosis and treatment options—a systematic review. Dtsch Arztebl Int 2017; 114: 875–82 VOLLTEXT
1.Herren C, Jung N, Pishnamaz M, Breuninger M, Siewe J, Sobottke R: Spondylodiscitis: diagnosis and treatment options—a systematic review. Dtsch Arztebl Int 2017; 114: 875–82 VOLLTEXT

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