Kim Jungok, Kim Yeon-Sook, Peck Kyong Ran, Kim Eun-Sang, Cho Sun Young, Ha Young Eun, Kang Cheol-In, Chung Doo Ryeon, Song Jae-Hoon
Division of Infectious Diseases, Sejong General Hospital, Seoul, South Korea.
Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
Semin Arthritis Rheum. 2014 Oct;44(2):246-52. doi: 10.1016/j.semarthrit.2014.04.008. Epub 2014 Apr 26.
Although pyogenic vertebral osteomyelitis (PVO) with no identified microorganism is treated empirically, the clinical outcome is not well understood.
We conducted a retrospective review of patients with PVO at a tertiary-care hospital from 2000 through 2012. The study compared clinical features and outcomes of microbiologically confirmed (M-PVO) with clinically diagnosed PVO (C-PVO).
Of 151 patients with PVO, 75 (49.7%) had M-PVO. Compared to patients with M-PVO, patients with C-PVO had fewer underlying medical conditions. In addition, they presented less frequently with fever, high acute-phase reactants levels, and paraspinal abscess. The rate of treatment failure tended to be lower in the C-PVO group [9.2% (7/76) vs. 17.3% (13/75); p = 0.157]. The overall relapse rate was 6.6% and did not differ significantly between groups; notably this rate was higher in patients who received antibiotics for ≤ 6 weeks [18.8% (3/16)] and ≤ 8 weeks [12.1% (4/33)]. The independent risk factors for treatment failure were higher CRP levels [odds ratio (OR) = 1.087; 95% confidence interval (CI): 1.025-1.153; p = 0.005] and fever ≥ 37.8°C (OR = 8.556; 95% CI: 2.273-32.207; p = 0.002).
Patients with C-PVO had less systemic inflammatory response and a more favorable outcome compared to M-PVO. Prolonged antibiotic therapy, for at least 8 weeks, might be required for C-PVO, as well as for M-PVO until better outcomes are assured.
虽然未明确微生物的化脓性脊椎骨髓炎(PVO)采用经验性治疗,但临床结果尚不清楚。
我们对2000年至2012年在一家三级医院的PVO患者进行了回顾性研究。该研究比较了微生物学确诊的PVO(M-PVO)和临床诊断的PVO(C-PVO)的临床特征和结果。
151例PVO患者中,75例(49.7%)为M-PVO。与M-PVO患者相比,C-PVO患者的基础疾病较少。此外,他们发热、急性期反应物水平升高和椎旁脓肿的表现频率较低。C-PVO组的治疗失败率倾向于较低[9.2%(7/76)对17.3%(13/75);p = 0.157]。总体复发率为6.6%,两组之间无显著差异;值得注意的是,接受抗生素治疗≤6周[18.8%(3/16)]和≤8周[12.1%(4/33)]的患者复发率更高。治疗失败的独立危险因素是较高的CRP水平[比值比(OR)= 1.087;95%置信区间(CI):1.025 - 1.153;p = 0.005]和发热≥37.8°C(OR = 8.556;95%CI:2.273 - 32.207;p = 0.002)。
与M-PVO相比,C-PVO患者的全身炎症反应较轻,预后较好。C-PVO以及M-PVO可能需要延长抗生素治疗至少8周,直到确保有更好的结果。