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脊椎骨髓炎抗生素治疗的最佳疗程

Optimal duration of antibiotic therapy in vertebral osteomyelitis.

作者信息

Roblot F, Besnier J M, Juhel L, Vidal C, Ragot S, Bastides F, Le Moal G, Godet C, Mulleman D, Azaïs I, Becq-Giraudon B, Choutet P

机构信息

Infectious Diseases Unit, CHU La Miletrie, Poitiers, France.

出版信息

Semin Arthritis Rheum. 2007 Apr;36(5):269-77. doi: 10.1016/j.semarthrit.2006.09.004. Epub 2007 Jan 3.

Abstract

OBJECTIVES

To compare the risk of relapse of vertebral osteomyelitis (VO), according to the duration of antibiotic therapy (< or =6 weeks versus >6 weeks).

METHODS

We performed a 10-year retrospective study to assess the risk of VO relapse and to verify that this risk was not enhanced in patients who received 6 weeks of antibiotic therapy (Group 1) as compared with those who received a longer treatment (Group 2). VO was diagnosed based on clinical manifestations, magnetic resonance imaging and/or computed tomography findings, and isolation of a pyogenic organism in blood cultures and/or a discovertebral biopsy. Relapse was diagnosed based on isolation of the same organism in blood cultures and/or a discovertebral biopsy. Outcome was evaluated 6 months post-treatment and in December 2004.

RESULTS

Group 1 included 36 patients (mean age, 58 +/- 15 years) and Group 2 included 84 patients (mean age, 67 +/- 15 years) (P = 0.003). Clinical data and microorganisms were comparable in the 2 groups. In the first 6 months, 6 (5%) patients died (Group 1, n = 2; Group 2, n = 4), and 5 (4%) in Group 2 relapsed, 2 with recurrent VO and 3 with recurrent bacteremia. In 2004, 91 patients were evaluated (mean follow-up, 40.6 +/- 31 months): 77 (85%) were cured, 13 (14%) died (Group 1, n = 3; Group 2, n = 10), 1 had VO due to a different microorganism (Group 2), and no long-term relapses occurred.

CONCLUSION

Our results suggest that antibiotic therapy of VO could be safely shortened to 6 weeks without enhancing the risk of relapse.

摘要

目的

根据抗生素治疗时长(≤6周与>6周)比较椎体骨髓炎(VO)复发风险。

方法

我们进行了一项为期10年的回顾性研究,以评估VO复发风险,并验证接受6周抗生素治疗的患者(第1组)与接受更长疗程治疗的患者(第2组)相比,复发风险是否未增加。VO根据临床表现、磁共振成像和/或计算机断层扫描结果以及血培养和/或椎间盘活检中分离出化脓性微生物进行诊断。复发根据血培养和/或椎间盘活检中分离出相同微生物进行诊断。治疗后6个月和2004年12月评估结果。

结果

第1组包括36例患者(平均年龄58±15岁),第2组包括84例患者(平均年龄67±15岁)(P = 0.003)。两组的临床数据和微生物情况具有可比性。在最初6个月内,6例(5%)患者死亡(第1组2例;第2组4例),第2组有5例(4%)复发,2例为复发性VO,3例为复发性菌血症。2004年,对91例患者进行了评估(平均随访40.6±31个月):77例(85%)治愈,13例(14%)死亡(第1组3例;第2组10例),1例(第2组)因不同微生物发生VO,未发生长期复发。

结论

我们的结果表明,VO的抗生素治疗可安全缩短至6周,而不会增加复发风险。

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