Department of Infectious Diseases, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
QJM. 2011 Mar;104(3):201-7. doi: 10.1093/qjmed/hcq178. Epub 2010 Oct 8.
Vertebral osteomyelitis (VO) is associated with considerable morbidity and its incidence seems to be increasing. Haematogenous spread is an important aetiological factor.
The objective was to describe a series of patients with VO and to search for a relationship between preceding bacteraemia and subsequent VO with the same pathogen.
A retrospective study of all treated cases of VO in a tertiary hospital over a 10-year period.
There were 129 cases of VO (involving 125 patients) that received antimicrobial treatment. Eighty-three (66%) were male and the mean age was 59.5 years (range 1 month to 87 years). The vertebral level involved was lumbar in 66 (53%) cases and thoracic in 35 (28%) cases. Seventy-four cases (59%) had a microbiologically confirmed aetiology. The diagnostic yield from procedures was 46 and 36% from blood culture and bone biopsy, respectively. Staphylococcus aureus was the most common pathogen [38 of 74 (51%) cases]. Nine of 38 (24%) cases of Staphylococcus aureus VO had a preceding bacteraemia with the same pathogen in the previous year.
Staphylococcus aureus is an important pathogen causing bacteraemia with the ability to cause metastatic complications including VO. The high proportion of cases developing VO following a documented bacteraemia, sometimes many months previously, reinforce the importance of adequate aggressive treatment for bacteraemia. VO must be considered in all patients presenting with back pain up to a year after bacteraemia. Previous bacteraemias with relevant pathogens can help guide antibiotic treatment at presentation of VO and if biopsy cannot be obtained.
椎体骨髓炎（VO）与相当大的发病率相关，其发病率似乎在增加。血源性播散是一个重要的病因。
描述一组 VO 患者，并寻找先前菌血症与随后相同病原体引起的 VO 之间的关系。
对一家三级医院 10 年来所有治疗的 VO 病例进行回顾性研究。
共有 129 例（涉及 125 例患者）接受了抗菌治疗的 VO 患者。83 例（66%）为男性，平均年龄为 59.5 岁（1 个月至 87 岁）。受累的椎体水平为腰椎 66 例（53%）和胸椎 35 例（28%）。74 例（59%）有微生物学证实的病因。从程序中获得的诊断产量分别为血液培养和骨活检的 46%和 36%。金黄色葡萄球菌是最常见的病原体[38 例（51%）]。38 例金黄色葡萄球菌 VO 中有 9 例（24%）在过去一年中发生过先前菌血症，且病原体相同。
金黄色葡萄球菌是引起菌血症的重要病原体，具有引起转移性并发症的能力，包括 VO。在许多个月前记录的菌血症后，有相当比例的患者发生 VO，这强化了对菌血症进行充分积极治疗的重要性。在发生菌血症后一年以内出现背痛的所有患者中，都应考虑 VO。先前有相关病原体的菌血症可有助于指导 VO 出现时的抗生素治疗，如果无法进行活检。
