经皮脊柱活检在脊柱感染中的治疗作用
Therapeutic impact of percutaneous spinal biopsy in spinal infection.
作者信息
Rankine J J, Barron D A, Robinson P, Millner P A, Dickson R A
机构信息
Department of Clinical Radiology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
出版信息
Postgrad Med J. 2004 Oct;80(948):607-9. doi: 10.1136/pgmj.2003.017863.
OBJECTIVE
To investigate the therapeutic impact of percutaneous spinal biopsy in patients with suspected spinal infection.
DESIGN AND PATIENTS
A review of the case notes and imaging features of 36 patients who underwent percutaneous spinal biopsy was performed. From this group 20 patients with a prebiopsy diagnosis of spinal osteomyelitis were identified. Management before biopsy was noted including the use of antimicrobial therapy. The results of the histology and microbiology were noted along with the subsequent diagnosis and management.
RESULTS
Eight of the 20 patients (40%) had received antibiotics before the biopsy. An organism was isolated in 8/20 cases (40%). Of the eight patients on antibiotics, two grew an organism (25%), including one case of candida in a patient receiving flucloxacillin. Out of 12 patients not on antibiotics there were six cases where an organism was isolated (50%). The result of the biopsy led to a change in management in seven of the 20 patients (35%).
CONCLUSIONS
Many clinicians are treating spinal osteomyelitis empirically with antibiotics before biopsy, but this reduces the chance of isolating an organism and determining antibiotic sensitivity. Despite this biopsy led to a change in management in 35% of cases.
目的
探讨经皮脊柱活检对疑似脊柱感染患者的治疗影响。
设计与患者
回顾了36例行经皮脊柱活检患者的病历及影像学特征。从该组中确定了20例活检前诊断为脊柱骨髓炎的患者。记录活检前的治疗情况，包括抗菌治疗的使用。记录组织学和微生物学结果以及后续的诊断和治疗情况。
结果
20例患者中有8例（40%）在活检前接受了抗生素治疗。20例中有8例（40%）分离出微生物。在接受抗生素治疗的8例患者中，2例培养出微生物（25%），其中1例接受氟氯西林治疗的患者感染念珠菌。在未接受抗生素治疗的12例患者中，有6例分离出微生物（50%）。活检结果导致20例患者中有7例（35%）的治疗方案发生改变。
结论
许多临床医生在活检前凭经验用抗生素治疗脊柱骨髓炎，但这会降低分离出微生物并确定抗生素敏感性的几率。尽管如此，活检仍使35%的病例治疗方案发生了改变。
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