Ganesh Devin, Gottlieb Jonathan, Chan Sherilynn, Martinez Octavio, Eismont Frank
From the *Orlando Health Orthopaedics Department, Orlando, FL †Department of Orthopaedics, University of Miami, Miami, FL ‡University of Miami, Coral Gables, FL.
Spine (Phila Pa 1976). 2015 Jun 15;40(12):E719-28. doi: 10.1097/BRS.0000000000000903.
Review of the literature.
To retrospectively examine the frequency of published fungal infections by species and the treatment algorithms used to eradicate the disease.
Fungal infections of the spine present unique challenges to the modern multispecialty treatment team. Although rare in comparison with bacterial infections, fungal infections have been increasing in incidence over the past several decades. Evidences-based practice is limited to referencing smaller case series.
MEDLINE, Scopus, and EMBASE searches were carried out by one of the authors as well as by the research desk at the University of Miami/Calder Memorial Library. We included peer-reviewed articles published between 1948 and September 2010; case reports, series, and reviews were all examined and compiled into a database.
A total of 130 articles, representing 157 cases, were included in the review. Aspergillus (60 cases, 38.2% of the total) and Candida species (36 cases, 22.9% of the total) were the 2 most common organisms. Surgery was associated with a greater survival rate than medical management alone in patients with Aspergillus (26.9% mortality in surgical patients; 60% in medically treated patients) and Candida (0% vs. 28.6%). Overall mortality was 19.3%. The overall recurrence rate was 7.4%. Amphotericin use was associated with a higher mortality rate than azoles.
Aspergillus is the most common published pathogen in fungal infections of the spine. Recent publications depicting the use of newer antifungal medications such as azoles report higher survival rates. Surgically treated patients in combination with antifungal therapy showed highest frequencies of patient survival in Aspergillus and Candida infections.
文献综述。
回顾性研究已发表的按菌种分类的真菌感染发生率以及用于根除该病的治疗方案。
脊柱真菌感染给现代多专科治疗团队带来了独特的挑战。尽管与细菌感染相比较为罕见，但在过去几十年中真菌感染的发生率一直在上升。循证医学实践仅限于参考较小的病例系列。
由一位作者以及迈阿密大学/卡尔德纪念图书馆的研究室对MEDLINE、Scopus和EMBASE进行检索。我们纳入了1948年至2010年9月间发表的经同行评审的文章；对病例报告、系列研究和综述均进行了审查并编入数据库。
该综述共纳入130篇文章，代表157例病例。曲霉菌（60例，占总数的38.2%）和念珠菌属（36例，占总数的22.9%）是最常见的两种病原体。在曲霉菌感染患者（手术患者死亡率为26.9%；药物治疗患者为60%）和念珠菌感染患者（分别为0%和28.6%）中，手术治疗组的生存率高于单纯药物治疗组。总体死亡率为19.3%。总体复发率为7.4%。使用两性霉素的死亡率高于使用唑类药物。
曲霉菌是已发表的脊柱真菌感染中最常见的病原体。近期描述使用新型抗真菌药物如唑类的文献报道生存率更高。在曲霉菌和念珠菌感染中，手术治疗联合抗真菌治疗的患者生存率最高。
3级。
