压力性溃疡相关的骨盆骨髓炎：被忽视的疾病？
Pressure Ulcer-Related Pelvic Osteomyelitis: A Neglected Disease?
机构信息
Divisions of Infectious Diseases and.
Divisions of Infectious Diseases and ; Emergency Medicine , Washington University School of Medicine , St. Louis, Missouri.
出版信息
Open Forum Infect Dis. 2015 Aug 6;2(3):ofv112. doi: 10.1093/ofid/ofv112. eCollection 2015 Sep.
Background. Decubitus ulcers can become complicated by pelvic osteomyelitis. Little is known about the epidemiology of pressure ulcer-related pelvic osteomyelitis. Methods. We performed a retrospective cohort study of adult patients with pressure ulcer and pelvic osteomyelitis admitted to an academic center from 2006 to 2011. Data on clinical presentation, diagnostic evaluation, and treatment during the index admission were collected. Outcome measures included length of hospital stay and number of readmissions in the subsequent year. Results. Two hundred twenty patients were included: 163 (74%) were para/quadriplegic and 148 (67%) were male (148; 67%). Mean age was 50 (±18) years. Pelvic osteomyelitis was the primary admission diagnosis for 117 (53%). Fifty-six (26%) patients had concurrent febrile urinary tract infection. Wound cultures collected for 113 patients (51%) were notable for methicillin-resistant Staphylococcus aureus (37; 33%), Streptococci (19; 17%), and Pseudomonas spp (20; 18%). Plain films were obtained in 89 (40%) patients, computed tomography scans were obtained for 81 (37%) patients, and magnetic resonance images were obtained for 40 (18%) patients. Most patients received osteomyelitis-directed antibiotics (153; 70%), 134 of 153 (88%) of which were scheduled to receive ≥6 weeks of treatment. Fifty-five (25%) patients underwent surgery during the index admission; 48 (22%) patients received a combined medical-surgical approach. One third of patients had ≥2 readmissions during the subsequent year. Patients treated with a combined approach were less likely to be readmitted than those who received antibiotics alone (0 [range, 0-4] vs 1 [0-7] readmissions; P = .04). Conclusions. This is one of the largest cohort studies of pressure ulcer-related pelvic osteomyelitis to date. Significant variations existed in diagnostic approach. Most patients received antibiotics; those treated with a combined medical-surgical approach had fewer hospital readmissions.
背景
压疮溃疡可并发骨盆骨髓炎。关于压疮相关骨盆骨髓炎的流行病学知识甚少。
方法
我们对 2006 年至 2011 年期间在一家学术中心因压疮和骨盆骨髓炎住院的成年患者进行了回顾性队列研究。收集了入院时的临床表现、诊断评估和治疗数据。主要结局指标包括住院时间和随后 1 年内的再入院次数。
结果
共纳入 220 例患者：163 例（74%）为截瘫/四肢瘫痪，148 例（67%）为男性（148 例；67%）。平均年龄为 50（±18）岁。骨盆骨髓炎是 117 例（53%）患者的主要入院诊断。56 例（26%）患者并发发热性尿路感染。113 例（51%）患者的伤口培养结果值得注意，其中耐甲氧西林金黄色葡萄球菌（37 例；33%）、链球菌（19 例；17%）和铜绿假单胞菌（20 例；18%）。89 例（40%）患者获得了平片，81 例（37%）患者获得了计算机断层扫描，40 例（18%）患者获得了磁共振成像。大多数患者接受了骨髓炎靶向抗生素治疗（153 例；70%），其中 153 例（88%）中的 134 例计划接受≥6 周的治疗。55 例（25%）患者在入院期间接受了手术；48 例（22%）患者接受了联合药物-手术治疗。三分之一的患者在随后的一年中有≥2 次再入院。接受联合治疗的患者再入院率低于单独接受抗生素治疗的患者（0[范围，0-4]次与 1[0-7]次；P=0.04）。
结论
这是迄今为止最大的压疮相关骨盆骨髓炎队列研究之一。诊断方法存在显著差异。大多数患者接受了抗生素治疗；接受联合药物-手术治疗的患者住院再入院次数较少。
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