Spinal infections with and without hardware: the viewpoint of an infectious disease specialist.

The incidence rate of spinal infections has been rising in last decades, and despite the advances in medicine, they still represent a therapeutic challenge, especially when related to spinal implants. The majority of spinal infections in developed world are caused by pyogenic bacteria, with Staphylococcus aureus as a leading cause among gram-positive cocci and Escherichia coli among gram-negative bacteria, whereas coagulase-negative staphylococci are frequently involved in implant-associated spinal infections. Implant-associated spinal infections are caused by bacteria capable of biofilm production on the implant surface rendering them resistant to majority of antimicrobial drugs. Spinal infections in patients without implants can be treated conservatively with pathogen-directed antimicrobial therapy, whereas in implant-associated spinal infections combined surgical and antibiotic therapy is necessary. Empiric antimicrobial treatment of spinal infections without microbiological diagnosis should be discouraged in the era of drug resistant pathogens.