Kang Seung-Ji, Jang Hee-Chang, Jung Sook-In, Choe Pyoeng Gyun, Park Wan Beom, Kim Chung-Jong, Song Kyoung-Ho, Kim Eu Suk, Kim Hong Bin, Oh Myoung-Don, Kim Nam Joong, Park Kyung-Hwa
Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
PLoS One. 2015 May 15;10(5):e0127126. doi: 10.1371/journal.pone.0127126. eCollection 2015.
There are limited data describing the clinical characteristics of pyogenic spondylitis caused by Gram-negative bacteria (GNB). The aim of this study was to investigate the predisposing factors and clinical characteristics of pyogenic spondylitis caused by GNB compared to Gram-positive cocci (GPC).
We performed a retrospective review of medical records from patients with culture-confirmed pyogenic spondylitis at four tertiary teaching hospitals over an 8-year period.
A total of 344 patients with culture-confirmed pyogenic spondylitis were evaluated. There were 62 patients (18.0%) with pyogenic spondylitis caused by GNB and the most common organism was Escherichia coli (n = 35, 10.2%), followed by Pseudomonas aeruginosa (n = 10, 2.9%). Pyogenic spondylitis caused by GNB was more frequently associated with the female gender (64.5 vs. 35.5%, P <0.01), preexisting or synchronous genitourinary tract infection (32.3 vs. 2.1%, P< 0.01), and intra-abdominal infection (12.9 vs. 0.4%, P< 0.01) compared to patients with GPC. Although pyogenic spondylitis caused by GNB presented with severe sepsis more frequently (24.2 vs. 11.3%, P = 0.01), the mortality rate (6.0 vs. 5.2%) and the proportion of patients with residual disability (6.0 vs. 9.0%), defined as grade 3 or 4 (P = 0.78) 3 months after completion of treatment, were not significantly different compared to GPC patients.
GNB should be considered as the etiologic organism when infectious spondylitis develops in a patient with preexisting or synchronous genitourinary tract and intra-abdominal infection. In addition, the mortality rate and clinical outcomes are not significantly different between pyogenic spondylitis caused by GNB and GPC.
关于革兰氏阴性菌(GNB)所致化脓性脊柱炎临床特征的数据有限。本研究旨在调查与革兰氏阳性球菌(GPC)相比,GNB所致化脓性脊柱炎的易感因素和临床特征。
我们对8年间4家三级教学医院确诊为化脓性脊柱炎患者的病历进行了回顾性分析。
共评估了344例确诊为化脓性脊柱炎的患者。其中62例(18.0%)为GNB所致化脓性脊柱炎,最常见的病原体是大肠埃希菌(n = 35,10.2%),其次是铜绿假单胞菌(n = 10,2.9%)。与GPC所致化脓性脊柱炎患者相比,GNB所致化脓性脊柱炎更常发生于女性(64.5%对35.5%,P <0.01)、存在或并发泌尿生殖道感染(32.3%对2.1%,P< 0.01)以及腹腔内感染(12.9%对0.4%,P< 0.01)。尽管GNB所致化脓性脊柱炎更常出现严重脓毒症(24.2%对11.3%,P = 0.01),但与GPC患者相比,治疗结束3个月时的死亡率(6.0%对5.2%)和残留残疾患者比例(6.0%对9.0%,定义为3级或4级,P = 0.78)并无显著差异。
对于存在或并发泌尿生殖道及腹腔内感染的患者发生感染性脊柱炎时,应考虑GNB为病原体。此外,GNB所致化脓性脊柱炎与GPC所致化脓性脊柱炎的死亡率和临床结局并无显著差异。