This spine surgery lecture covers antibiotic treatment of spinal wound infections. Post-operative infection is multifactorial. S. aureus is an important pathogen in all wound infections but, in late onset implant infections, Proprionobacteria and Coagulase negative Staphylococci must also be considered. Samples are important to establish the causative organism(s). Antibiotic treatment should be reviewed and rationalised with the results of cultures. Surgical debridement is important and a surgical emergency if signs of septic shock or rapidly spreading infection occur despite treatment.

Vertebral OM, discitis, and epidural abscess often occur as a result of haematogenous seeding. S. aureus is the most common cause of vertebral OM, discitis and epidural abscess but there are multiple other causative organisms which need to be considered. Empirical approaches are becoming less effective due to increasing resistance. Except in septic patients or patients with neurological compromise, empirical therapy should be withheld when possible until a microbiological diagnosis has been confirmed and targeted therapy initiated. An image-guided or intra-operative aspiration or biopsy of disc space or vertebral endplate sample submitted for microbiological and histological examination often establishes the microbiological or pathological diagnosis.