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Pyogenic spondylitis is a challenging condition that requires early and accurate diagnosis for appropriate treatment. Most cases can be treated non-surgically or with minimally invasive surgical procedures; however, a combination of anterior debridement/bone grafting and posterior fixation is necessary for severe cases. We encountered a case of lumbar pyogenic spondylitis treated with anterior debridement and autogenous bone grafting after percutaneous endoscopic discectomy drainage (PEDD) with percutaneous pedicle screw (PPS) fixation. The continuous pus oozing from the PEDD drainage tube wound was characteristic in this case, and the pus was considered to be caused by secondary infection/microbial substitution. The discharge immediately stopped and healed after anterior debridement and autogenous bone grafting.  Escherichia coli  was first detected as the causative bacterium, and  Corynebacterium amycolatum  and  Corynebacterium striatum  were detected as the cause of secondary infection/microbial substitution. The possibility of secondary infection/microbial substitution should be considered when the clinical course worsens.

Secondary Infection/Microbial Substitution in a Managed Case of Pyogenic Spondylitis