Zalavras Charalampos G, Gupta Neeraj, Patzakis Michael J, Holtom Paul D
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, LAC-USC Medical Center, Los Angeles, CA 90033, USA.
Clin Orthop Relat Res. 2005 Oct;439:97-100. doi: 10.1097/01.blo.0000181498.49740.ac.
Osteomyelitis rarely develops in patients infected with the human immunodeficiency virus despite their immunosuppressed state. In the limited literature available on this subset of patients, the role of opportunistic micro-organisms is controversial. Our purpose is to describe the microbiologic features of osteomyelitis. This is a retrospective review of 20 patients infected with the human immunodeficiency virus who were admitted to our musculoskeletal infection ward with the diagnosis of osteomyelitis. Eleven patients (55%) were intravenous drug users. Medical comorbidities were present in 14 of 20 patients (70%), including tuberculosis in five patients and hepatitis C in three patients. The mean CD4 count was 269/mm (range, 20-539/mm). Osteomyelitis was monomicrobial in 10 patients (50%) and polymicrobial in seven patients (35%) whereas in three patients no organism was cultured. The most common pathogen was Staphylococcus aureus, present in 10 patients (50%). No mycobacterial or fungal pathogens were identified. Infection recurred in 3 of 14 patients (21%) that were available for followup. Despite their immunocompromised status, patients infected with the human immunodeficiency virus did not develop osseous infections with opportunistic pathogens. Staphylococcus aureus was the most common pathogen found; however, a considerable proportion of infections were polymicrobial.
尽管感染人类免疫缺陷病毒的患者处于免疫抑制状态，但骨髓炎很少发生。在关于这类患者的有限文献中，机会性微生物的作用存在争议。我们的目的是描述骨髓炎的微生物学特征。这是一项对20例感染人类免疫缺陷病毒且因骨髓炎诊断入住我们肌肉骨骼感染病房的患者的回顾性研究。11例患者（55%）为静脉吸毒者。20例患者中有14例（70%）存在合并症，包括5例患有结核病，3例患有丙型肝炎。平均CD4细胞计数为269/mm³（范围为20 - 539/mm³）。10例患者（50%）的骨髓炎为单一微生物感染，7例患者（35%）为多微生物感染，而3例患者未培养出微生物。最常见的病原体是金黄色葡萄球菌，10例患者（50%）感染该菌。未鉴定出分枝杆菌或真菌病原体。14例可进行随访的患者中有3例（21%）感染复发。尽管感染人类免疫缺陷病毒的患者免疫功能受损，但他们并未发生由机会性病原体引起的骨感染。金黄色葡萄球菌是最常见的病原体；然而，相当一部分感染是多微生物感染。
