Kowalski Todd J, Berbari Elie F, Huddleston Paul M, Steckelberg James M, Osmon Douglas R
Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Clin Infect Dis. 2006 Jul 15;43(2):172-9. doi: 10.1086/505118. Epub 2006 Jun 5.
The ability of follow-up imaging examinations to predict treatment failure in patients with spine infections has not been well studied.
We conducted a retrospective cohort analysis of patients with spine infection who had both baseline and 4-8-week follow-up imaging results available at the Mayo Clinic (Rochester, MN) during the period of 1994-2002. Follow-up imaging findings were categorized as improved, equivocal, or worse, compared with the baseline findings, on the basis of a simple grading system that focused on associated soft-tissue findings.
Baseline and 4-8-week follow-up imaging findings were available for 79 patients with spine infection who presented to the Mayo Clinic during 1994-2002. Thirty-five infections (44%) were due to Staphylococcus aureus, 9 (11%) were due to coagulase-negative staphylococci, and 16 (20%) were culture negative. Twenty-seven (34%), 38 (48%), and 14 (18%) follow-up images were graded improved, equivocal, or worse, respectively. The cumulative rates of 1-year survival free of microbiologically confirmed treatment failure were 100%, 89% (95% CI, 74%-96%), and 56% (95% CI, 24%-83%) for patients with improved, equivocal, and worse follow-up imaging findings, respectively (P=.004). Only 3 (6%) of 52 patients deemed to have had clinical improvement at the time of the follow-up imaging study experienced treatment failure. Elevated levels of inflammatory biomarkers identified 2 of these patients as high risk for treatment failure, and the levels were not performed for the third patient.
Applying a simple grading scale to assess follow-up imaging examinations for patients with spinal infection stratifies their risk of treatment failure. Patients' clinical statuses and inflammatory biomarker responses may be helpful for selecting patients at high risk for treatment failure who should undergo follow-up magnetic resonance imaging.
后续成像检查预测脊柱感染患者治疗失败的能力尚未得到充分研究。
我们对1994年至2002年期间在梅奥诊所（明尼苏达州罗切斯特）有基线和4至8周随访成像结果的脊柱感染患者进行了回顾性队列分析。根据一个侧重于相关软组织表现的简单分级系统，将随访成像结果与基线结果相比分为改善、不明确或恶化。
1994年至2002年期间在梅奥诊所就诊的79例脊柱感染患者有基线和4至8周随访成像结果。35例感染（44%）由金黄色葡萄球菌引起，9例（11%）由凝固酶阴性葡萄球菌引起，16例（20%）培养阴性。随访图像分别有27例（34%）、38例（48%）和14例（18%）被评为改善、不明确或恶化。随访成像结果改善、不明确和恶化的患者1年无微生物学证实治疗失败的累积生存率分别为100%、89%（95%CI，74%-96%）和56%（95%CI，24%-83%）（P = 0.004）。在随访成像研究时被认为临床有改善的52例患者中，只有3例（6%）出现治疗失败。炎症生物标志物水平升高将其中2例患者识别为治疗失败的高危患者，第3例患者未检测炎症生物标志物水平。
应用简单分级量表评估脊柱感染患者的随访成像检查可对其治疗失败风险进行分层。患者的临床状态和炎症生物标志物反应可能有助于选择应接受随访磁共振成像检查的治疗失败高危患者。
