Al-Nammari Shafic Said, Lucas Jonathan D, Lam Khai S
Guy's & St. Thomas' Hospitals NHS Trust, London, United Kingdom.
Spine (Phila Pa 1976). 2007 Oct 15;32(22):2480-6. doi: 10.1097/BRS.0b013e318157393e.
Retrospective case series.
To determine relevant demographics, clinical presentations, and outcomes of this condition.
This is the first study looking specifically at methicillin-resistant Staphylococcus Aureus (MRSA) spondylodiscitis.
We performed a retrospective review of patients presenting between 2000 and 2005.
Thirteen cases were identified. The mean age was 65 years; 85% were male. All cases presented with back pain, spinal tenderness, and systemic upset. Neurologic deficit was present initially in 39%, and 8% developed neurologic deterioration during treatment. The thoracic spine (53%) was most commonly affected, followed by the lumbar (33%), thoracolumbar junction (7%), and cervical spine (7%); 16% of cases were multilevel. The white cell count, erythrocyte sedimentation rate and C-reactive protein were elevated in all cases with means of 17.3 x 10(-9)/L, 102 mm/h, and 236 mg/L, respectively. Radiologic diagnosis was established with MRI in all cases. The most common risk factors were diabetes mellitus (62%), malnourishment (54%), cirrhosis (31%), end-stage renal failure (15%), and intravenous drug use (15%). Multiple risk factors were present in 76% of cases, and only 15% had no identifiable risk factors. The main sources of sepsis were intravenous catheters (23%), urinary tract (15%), and intravenous drug use (15%). Treatment consisted of intravenous vancomycin monotherapy for a mean period of 4 weeks followed by oral combination or monotherapy antimicrobials for a mean period of 8 weeks. Operative intervention was required in 38% of cases. At 6 months, 54% of cases were clinically free of infection, 38% had died, and 8% required ongoing treatment. Neurologic deficit was present in 50% of survivors. At 1 year, 29% of survivors had MRSA bacteremia and spondylodiscitis recurrence.
This is a devastating condition with high mortality and morbidity.
回顾性病例系列研究。
确定该疾病的相关人口统计学特征、临床表现及预后。
这是第一项专门针对耐甲氧西林金黄色葡萄球菌（MRSA）性脊椎间盘炎的研究。
我们对2000年至2005年间就诊的患者进行了回顾性分析。
共确定13例病例。平均年龄为65岁；85%为男性。所有病例均有背痛、脊柱压痛及全身不适症状。最初39%的病例存在神经功能缺损，8%在治疗期间出现神经功能恶化。胸椎（53%）最常受累，其次是腰椎（33%）、胸腰段交界处（7%）和颈椎（7%）；16%的病例为多节段病变。所有病例白细胞计数、红细胞沉降率和C反应蛋白均升高，平均值分别为17.3×10⁻⁹/L、102mm/h和236mg/L。所有病例均通过磁共振成像（MRI）确立放射学诊断。最常见的危险因素为糖尿病（62%）、营养不良（54%）、肝硬化（31%）、终末期肾衰竭（15%）及静脉药物滥用（15%）。76%的病例存在多种危险因素，仅15%无明确危险因素。脓毒症的主要来源为静脉导管（23%）、泌尿系统（15%）及静脉药物滥用（15%）。治疗包括平均为期4周的静脉万古霉素单一疗法，随后平均为期8周的口服联合或单一抗菌药物治疗。38%的病例需要手术干预。6个月时，54%的病例临床感染已愈，38%死亡，8%需要持续治疗。50%的幸存者存在神经功能缺损。1年时，29%的幸存者发生MRSA菌血症及脊椎间盘炎复发。
这是一种具有高死亡率和高发病率的严重疾病。
