Chen Wan-Chin, Wang Jiun-Ling, Wang Jann-Tay, Chen Yee-Chun, Chang Shan-Chwen
Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital College of Medicine, Taipei, Taiwan.
J Microbiol Immunol Infect. 2008 Jun;41(3):215-21.
Despite advances in diagnosis and treatment, spinal epidural abscess due to Staphylococcus aureus remains a challenge to clinicians. In this study, we describe the clinical features and outcomes of patients with spinal epidural abscess due to S. aureus.
Thirty one cases of spinal epidural abscess due to S. aureus treated at the National Taiwan University Hospital from January 2001 to December 2006 were retrospectively reviewed, using a standardized case collection form. Spinal epidural abscess was diagnosed by computed tomography or magnetic resonance imaging of the spine.
The median age of subjects was 55 years (range, 20 to 90 years) and the male-to-female ratio was 4.2. All patients had spine pain and 18 (58.1%) had fever. Lumbar or lumbosacral region was the most frequently involved site of spinal epidural abscess (61.3%), and 83.9% of the patients also had vertebral osteomyelitis. Sixteen patients (51.6%) were treated successfully with antibiotics alone for a median duration of 70 days (range, 23 to 274 days), whereas the median duration of antibiotic therapy in patients undergoing surgical intervention was 102 days (range, 40 to 227 days). Renal failure, malignancy or underlying comorbid illness estimated by Charlson score was predictive of a poor prognosis with treatment failure or mortality.
Although medical treatment alone might benefit selected patients with spinal epidural abscess due to S. aureus and minimal neurologic sequelae, close monitoring of the evolution of neurologic deficits with radiographic imaging follow-up is necessary, since the rate of progression of neurologic impairment is difficult to predict.
尽管在诊断和治疗方面取得了进展，但金黄色葡萄球菌引起的脊柱硬膜外脓肿对临床医生来说仍是一项挑战。在本研究中，我们描述了金黄色葡萄球菌引起的脊柱硬膜外脓肿患者的临床特征和预后。
回顾性分析2001年1月至2006年12月在台湾大学医院接受治疗的31例金黄色葡萄球菌引起的脊柱硬膜外脓肿病例，使用标准化病例收集表。通过脊柱计算机断层扫描或磁共振成像诊断脊柱硬膜外脓肿。
受试者的中位年龄为55岁（范围20至90岁），男女比例为4.2。所有患者均有脊柱疼痛，18例（58.1%）有发热。腰椎或腰骶部是脊柱硬膜外脓肿最常累及的部位（61.3%），83.9%的患者还患有椎体骨髓炎。16例患者（51.6%）仅接受抗生素治疗成功，中位治疗时间为70天（范围23至274天），而接受手术干预的患者抗生素治疗的中位时间为102天（范围40至227天）。根据Charlson评分估计的肾衰竭、恶性肿瘤或潜在合并症是治疗失败或死亡预后不良的预测因素。
尽管单独的药物治疗可能使某些金黄色葡萄球菌引起的脊柱硬膜外脓肿且神经后遗症轻微的患者受益，但由于神经功能损害的进展速度难以预测，因此有必要通过影像学随访密切监测神经功能缺损的演变。
