Saint Joseph Mercy Hospital , Ann Arbor, Michigan.
Veterans Affairs Ann Arbor Healthcare System and the University of Michigan Medical School , Ann Arbor, Michigan.
Open Forum Infect Dis. 2014 May 14;1(1):ofu022. doi: 10.1093/ofid/ofu022. eCollection 2014 Mar.
A nationwide outbreak of fungal infections was traced to injection of Exserohilum-contaminated methylprednisolone. We describe our experience with patients who developed spinal or paraspinal infection after injection of contaminated methylprednisolone.
Data were assembled from the Michigan Department of Community Health, electronic medical records, and magnetic resonance imaging (MRI) reports.
Of 544 patients who received an epidural injection from a contaminated lot of methylprednisolone at a pain clinic in southeastern Michigan, 153 (28%) were diagnosed at our institution with probable or confirmed spinal or paraspinal fungal infection at the injection site. Forty-one patients had both meningitis and spinal or paraspinal infection, and 112 had only spinal or paraspinal infection. Magnetic resonance imaging abnormalities included abscess, phlegmon, arachnoiditis, and osteomyelitis. Surgical debridement in 116 patients revealed epidural phlegmon and epidural abscess most often. Among 26 patients with an abnormal MRI but with no increase or change in chronic pain, 19 (73%) had infection identified at surgery. Fungal infection was confirmed in 78 patients (51%) by finding hyphae in tissues, positive polymerase chain reaction, or culture. Initial therapy was voriconazole plus liposomal amphotericin B in 115 patients (75%) and voriconazole alone in 38 patients (25%). As of January 31, 2014, 20 patients remained on an azole agent. Five patients died of infection.
We report on 153 patients who had spinal or paraspinal fungal infection at the site of epidural injection of contaminated methylprednisolone. One hundred sixteen (76%) underwent operative debridement in addition to treatment with antifungal agents.
真菌性感染的全国性爆发可追溯至注射被外瓶霉属污染的甲基强的松龙。我们描述了在注射被污染的甲基强的松龙后发生脊柱或脊柱旁感染的患者的经验。
数据来自密歇根州社区卫生署、电子病历和磁共振成像（MRI）报告。
在密歇根州东南部一家疼痛诊所，有 544 名患者接受了被污染批次的甲基强的松龙硬膜外注射，其中 153 名（28%）在我们机构被诊断为可能或确诊的注射部位脊柱或脊柱旁真菌感染。41 名患者既有脑膜炎又有脊柱或脊柱旁感染，112 名患者只有脊柱或脊柱旁感染。MRI 异常包括脓肿、蜂窝织炎、蛛网膜炎和骨髓炎。116 名患者进行了手术清创，最常见的是硬膜外蜂窝织炎和硬膜外脓肿。在 26 名 MRI 异常但慢性疼痛无增加或改变的患者中，19 名（73%）在手术中发现了感染。78 名患者（51%）通过组织中发现的菌丝、聚合酶链反应阳性或培养物确认了真菌感染。115 名患者（75%）接受了伏立康唑联合两性霉素 B 脂质体治疗，38 名患者（25%）单独接受了伏立康唑治疗。截至 2014 年 1 月 31 日，20 名患者仍在使用唑类药物。5 名患者死于感染。
我们报告了 153 名患者在接受被外瓶霉属污染的甲基强的松龙硬膜外注射后发生脊柱或脊柱旁真菌感染。116 名患者（76%）除了接受抗真菌药物治疗外，还进行了手术清创。
