自发性凝固酶阴性葡萄球菌性脊椎椎间盘炎的特征：与金黄色葡萄球菌性脊椎椎间盘炎的回顾性比较研究
Characteristics of spontaneous coagulase-negative staphylococcal spondylodiscitis: a retrospective comparative study versus Staphylococcus aureus spondylodiscitis.
作者信息
Lopez Julien, Tatar Zuzana, Tournadre Anne, Couderc Marion, Pereira Bruno, Soubrier Martin, Dubost Jean-Jacques
机构信息
Department of Rheumatology, University Hospital Gabriel Montpied, 58 rue Montalembert, 63003, Clermont Ferrand CEDEX 1, France.
Biostatistics Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
出版信息
BMC Infect Dis. 2017 Oct 13;17(1):683. doi: 10.1186/s12879-017-2783-0.
BACKGROUND
Coagulase-negative staphylococci (CoNS) are increasingly implicated in recent patient series of spondylodiscitis, but there are no series of CoNS-spondylodiscitis available. The objective of this study was to compare the characteristics of patients with spontaneous CoNS-spondylodiscitis with those patients with Staphylococcus aureus (SA) spondylodiscitis.
METHODS
This was a retrospective single center study involving 147 spontaneous infectious spondylodiscitis cases observed between 2000 and 2015. The 26 cases of CoNS-spondylodiscitis (15 confirmed) were compared with 30 cases of SA-spondylodiscitis. CoNS infection was considered confirmed if the same CoNS was isolated in at least two samples at two different times.
RESULT
Patients with CoNS-spondylodiscitis were older (70 vs. 61 years of age; p = 0.01), had associated cancer more often (15% vs. 0%; p = 0.04) and had a longer diagnostic delay (>15 days in 88% vs. 60%; p = 0.01); experienced fever less often (19% vs. 50%; p = 0.01), and had lower white blood cell (7.6 vs. 9.9G/L; p = 0.01) and polymorphonuclear leucocyte counts (5.6 vs. 7.5G/L; p = 0.04). Patients with CoNS spondylodiscitis had less pronounced inflammatory syndrome (erythrocyte sedimentation rate [ESR]: 62 vs. 81 mm at 1 h; p = 0.03; CRP: 60 vs. 147 mg/L; p = 0.0003) and less common (ESR < 30 mm: 23% vs. 0%; p = 0.01; CRP < 10 mg/L: 23% vs. 0%; p = 0.005) in comparison with patients with SA infection. The infection entry site was most often an intravascular catheter (20% vs. 3%; p = 0.008). The level of positive percutaneous needle biopsies was comparable between CoNS and SA. Two patients who died both had SA infections.
CONCLUSION
CoNS-spondylodiscitis involved at least 10% of spontaneous spondylodiscitis cases and was more common in elderly patients, afflicted by comorbidities, and its presentation was less virulent than that of those with SA-spondylodiscitis.
背景
凝固酶阴性葡萄球菌（CoNS）在近期的脊椎椎间盘炎患者系列研究中越来越多地被牵涉其中，但尚无关于CoNS所致脊椎椎间盘炎的系列研究。本研究的目的是比较自发性CoNS所致脊椎椎间盘炎患者与金黄色葡萄球菌（SA）所致脊椎椎间盘炎患者的特征。
方法
这是一项回顾性单中心研究，纳入了2000年至2015年间观察到的147例自发性感染性脊椎椎间盘炎病例。将26例CoNS所致脊椎椎间盘炎病例（15例确诊）与30例SA所致脊椎椎间盘炎病例进行比较。如果在两个不同时间的至少两个样本中分离出相同的CoNS，则认为CoNS感染确诊。
结果
CoNS所致脊椎椎间盘炎患者年龄较大（70岁对61岁；p = 0.01），合并癌症的情况更常见（15%对0%；p = 0.04），诊断延迟更长（88%患者>15天对60%；p = 0.01）；发热情况较少见（19%对50%；p = 0.01），白细胞计数较低（7.6对9.9G/L；p = 0.01）以及多形核白细胞计数较低（5.6对7.5G/L；p = 0.04）。与SA感染患者相比，CoNS所致脊椎椎间盘炎患者的炎症综合征不那么明显（红细胞沉降率[ESR]：1小时时62对81mm；p = 0.03；C反应蛋白[CRP]：60对147mg/L；p = 0.0003）且更不常见（ESR<30mm：23%对0%；p = 0.01；CRP<10mg/L：23%对0%；p = 0.005）。感染入口部位最常见的是血管内导管（20%对3%；p = 0.008）。CoNS和SA的经皮穿刺针活检阳性率相当。两名死亡患者均为SA感染。
结论
CoNS所致脊椎椎间盘炎至少占自发性脊椎椎间盘炎病例的10%，在老年患者、患有合并症的患者中更常见，其临床表现的毒性低于SA所致脊椎椎间盘炎患者。
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