血液透析患者感染性脊柱骨髓炎的流行病学和结局。

Epidemiology and Outcomes of Infectious Spondylodiscitis in Hemodialysis Patients.

机构信息

Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

出版信息

Spine (Phila Pa 1976). 2018 Jun 15;43(12):869-876. doi: 10.1097/BRS.0000000000002443.

DOI:10.1097/BRS.0000000000002443

PMID:29016441

Abstract

STUDY DESIGN

A retrospective study of patients who were hospitalized for infectious spondylodiscitis over a 13-year period.

OBJECTIVE

To elucidate the epidemiology and prognostic factors of infectious spondylodiscitis in hemodialysis (HD) patients and to identify the impact of HD on infectious spondylodiscitis.

SUMMARY OF BACKGROUND DATA

Only a few case studies of infectious spondylodiscitis in HD patients can be found in the literature. Reports of prognostic factors are limited and patients' outcomes have not been well described.

METHODS

The cases of 1402 patients who were hospitalized for infectious spondylodiscitis over a 13-year period were retrospectively reviewed. Of these, 102 patients on maintenance HD were enrolled in this study. Cox proportional hazard model was used to evaluate the risk factors of mortality and recurrence.

RESULTS

The 102 enrolled patients had an average age 63.3 ± 11.2 years old and male-to-female ratio of 1:1.04. Back pain was present in 75.5% of patients and the most commonly infected site was the lumbosacral spine. Infection associated with vascular access was identified in 31.4% of patients. The prevalence of dialysis via central venous catheters was higher than prevalent HD patients. Methicillin-resistant Staphylococcus aureus was the most common pathogen, followed coagulase-negative staphylococci. The patients' in-hospital survival rate was 82.4%; their vascular access survival rate was 75.5%; their 1-year survival rate was 78.4%, and their 1-year recurrence rate was 20.2%. Congestive heart failure was associated with an increased 1-year mortality. Other variables exhibited no significant relationship with patients' in-hospital mortality, 1-year mortality or recurrence.

CONCLUSION

The characteristics and outcomes of infectious spondylodiscitis in HD patients were elucidated. Most of the demographic and clinical variables, evaluated upon admission, did not predict mortality or recurrence.

LEVEL OF EVIDENCE

摘要

研究设计

对 13 年间因感染性脊椎骨髓炎住院的患者进行回顾性研究。

目的

阐明血液透析（HD）患者感染性脊椎骨髓炎的流行病学和预后因素，并确定 HD 对感染性脊椎骨髓炎的影响。

背景资料概要

文献中仅能找到少数关于 HD 患者感染性脊椎骨髓炎的病例研究。有关预后因素的报告有限，且患者的预后情况并未得到很好的描述。

方法

对 13 年间因感染性脊椎骨髓炎住院的 1402 例患者的病例进行回顾性分析。其中，102 例维持性 HD 患者纳入本研究。采用 Cox 比例风险模型评估死亡率和复发的危险因素。

结果

纳入的 102 例患者平均年龄为 63.3±11.2 岁，男女比例为 1:1.04。75.5%的患者存在背痛，最常感染的部位是腰骶部脊柱。31.4%的患者感染与血管通路有关。经中心静脉导管进行透析的患病率高于普通 HD 患者。耐甲氧西林金黄色葡萄球菌是最常见的病原体，其次是凝固酶阴性葡萄球菌。患者的住院生存率为 82.4%；血管通路生存率为 75.5%；1 年生存率为 78.4%，1 年复发率为 20.2%。充血性心力衰竭与 1 年死亡率增加相关。其他变量与患者住院死亡率、1 年死亡率或复发无显著关系。