Abstract / Summary
Objective: This study aimed to describe the clinical, microbiological, and treatment characteristics of anaerobic infectious spondylitis identified through open surgical tissue culture.Methods: We retrospectively reviewed patients who underwent open surgical treatment for infectious spondylitis at a single center between 2006 and 2023.Intraoperative specimens were submitted for aerobic and anaerobic culture; mycobacterial and fungal studies were performed when clinically indicated.After culture-negative, tuberculous, and fungal cases were excluded, patients with culture-confirmed bacterial pyogenic spondylitis constituted the analytic denominator, and those with anaerobic infection were analyzed.Results: Among surgically treated patients with culture-confirmed bacterial pyogenic spondylitis, anaerobic organisms were identified in 8 of 214 patients (3.7%); 6 were obligate anaerobes and 2 were aerotolerant Cutibacterium acnes.Isolates included Bacteroides fragilis (n = 2), Porphyromonas gingivalis, Clostridium ramosum, Parvimonas micra, Veillonella parvula, and C. acnes (n = 2).The mean age was 62.8 years, and 7 patients were male.Low back pain was the most common symptom (5 patients), whereas only 2 patients had fever.Polymicrobial infection occurred in 3 patients.Most patients initially received conventional empirical antibiotics directed against aerobic pathogens, and only 2 patients received a metronidazole-containing regimen before microbiological confirmation.The mean duration of antibiotic therapy was 11.3 weeks.Infection was controlled in 7 patients; 1 patient with polymicrobial infection had recurrence requiring repeat culture evaluation and implant removal.Conclusion: Anaerobic infectious spondylitis was uncommon in this surgically treated cohort, and these clinical features should be interpreted cautiously because no aerobic comparison group was included.Although routine empirical anaerobic coverage cannot be recommended on the basis of these data, it may be considered when anaerobic infection is clinically suspected.Accurate anaerobic culture from surgical tissue remains important for guiding targeted antimicrobial therapy.