Department of Infectious Diseases, Hospital Universitario de Bellvitge, Barcelona, Spain.
Semin Arthritis Rheum. 2011 Oct;41(2):247-55. doi: 10.1016/j.semarthrit.2011.04.002. Epub 2011 Jun 12.
The observed higher incidence of pyogenic vertebral osteomyelitis (PVO) may entail an increasing number of patients with no microbiologic diagnosis. The true incidence of these cases, how exhaustive the etiologic diagnostic efforts must be, and the usefulness of an empirical antibiotic therapy are not well defined.
Retrospective analysis of all cases of vertebral osteomyelitis in our center (1991-2009) and retrospective analysis of cases of PVO (2005-2009). Clinical data, diagnostic procedures, treatment, and outcome were reviewed. A comparative analysis between microbiologically confirmed PVO (MCPVO) and probable PVO (PPVO) was performed.
Increasing incidence of PVO (+0.047 episodes/100,000 inhabitants-year). During the last decade, there was an increase of PPVO (+0.059 episodes/100,000 inhabitants-year) with stable incidence of MCPVO. During 2005-2009, there were 72 patients [47 (65%) MCPVO and 25 (35%) PPVO]. 60% men; mean age was 66 years. Bacteremia was found in 59%. Computed tomographic guided vertebral biopsy, positive in 7/36 (19%), was more successful among patients with bacteremia. Among MCPVO, there was an increasing proportion of less virulent bacteria. Cases of MCPVO presented more frequently with sepsis, fever, and high acute-phase reactants, and PPVO cases were mostly treated with oral fluoroquinolones plus rifampin. No differences were found between both groups in outcome (93% success, 22% sequelae).
An epidemiologic change of PVO is suggested by a higher incidence of PPVO and the isolation of less virulent microorganisms among MCPVO. In this setting, the availability of an oral and effective empirical antibiotic therapy may challenge an exhaustive prosecution of the etiology.
观察到化脓性脊柱骨髓炎（PVO）的发病率较高，可能导致越来越多的患者无法进行微生物诊断。这些病例的真实发病率、病因诊断工作必须达到何种详尽程度以及经验性抗生素治疗的效果均不明确。
回顾性分析我院（1991-2009 年）所有脊柱骨髓炎病例和 2005-2009 年化脓性脊柱骨髓炎病例。对临床数据、诊断程序、治疗和结局进行了回顾性分析。对微生物学确诊化脓性脊柱骨髓炎（MCPVO）和可能化脓性脊柱骨髓炎（PPVO）进行了对比分析。
PVO 的发病率呈上升趋势（每 10 万人/年增加 0.047 例）。在过去十年中，PPVO 的发病率增加（每 10 万人/年增加 0.059 例），而 MCPVO 的发病率保持稳定。2005-2009 年，共有 72 例患者（47 例 MCPVO，25 例 PPVO），其中 60%为男性，平均年龄为 66 岁。59%患者存在菌血症。经 CT 引导的脊柱活检阳性率为 7/36（19%），在有菌血症的患者中更有成效。MCPVO 中的致病菌毒力逐渐减弱。MCPVO 病例更常表现为败血症、发热和急性期反应物升高，而 PPVO 病例多采用口服氟喹诺酮类药物加利福平治疗。两组患者的结局（成功率 93%，后遗症发生率 22%）无差异。
PVO 的发病率较高，MCPVO 中的致病菌毒力减弱，提示其流行病学特征发生了变化。在这种情况下，口服且有效的经验性抗生素治疗可能会挑战病因学的详尽探究。
