Kuo George, Sun Wei-Chiao, Lu Yueh-An, Chen Chao-Yu, Kao Huang-Kai, Lin Yu, Chen Yung-Chang, Hung Cheng-Chieh, Tian Ya-Chung, Hsu Hsiang-Hao
Department of Nephrology, Kidney Research Center, College of Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Department of Plastic and Reconstructive Surgery, College of Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Ther Clin Risk Manag. 2018 Feb 13;14:257-263. doi: 10.2147/TCRM.S153546. eCollection 2018.
Infectious spondylodiscitis is a serious disease that can lead to permanent neurological deficit. Because there were only a few case reports or series featuring infectious spondylodiscitis in chronic dialysis patients, we investigated the epidemiology and outcome in the chronic dialysis patients versus general population.
We retrospectively identified chronic dialysis patients admitted for infectious spondylodiscitis between January 2002 and December 2015. A total of 105 chronic dialysis patients were included, and we performed a 1:2 case-control match on propensity score in non-dialysis patients with infectious spondylodiscitis. The demographic features, clinical manifestation, infection focus, and disease outcome were recorded.
A total of 302 patients entered the final analysis. Chronic dialysis patients less frequently had fever (34.3%), and in the majority, bacterial entry was through dialysis vascular access (30.5%). Methicillin-resistant (MRSA) comprised the majority of causative pathogen. The chronic dialysis group had longer hospital stay, higher in-hospital mortality, and higher 1-year mortality. The odds ratio of in-hospital mortality was 2.20 compared with the non-dialysis group.
The study highlighted poorer outcome and high frequency of resistant Staphylococcus of infectious spondylodiscitis in chronic dialysis patients. Therefore, high vigilance, prompt recognition, and empiric coverage of MRSA will be important in the management of infectious spondylodiscitis in chronic dialysis patients.
感染性脊椎间盘炎是一种严重疾病，可导致永久性神经功能缺损。由于仅有少数病例报告或系列研究关注慢性透析患者的感染性脊椎间盘炎，我们对慢性透析患者与普通人群中感染性脊椎间盘炎的流行病学及预后进行了调查。
我们回顾性确定了2002年1月至2015年12月期间因感染性脊椎间盘炎入院的慢性透析患者。共纳入105例慢性透析患者，并对感染性脊椎间盘炎的非透析患者按倾向评分进行1:2病例对照匹配。记录人口统计学特征、临床表现、感染源及疾病转归。
共有302例患者进入最终分析。慢性透析患者发热情况较少见（34.3%），多数情况下细菌通过透析血管通路侵入（30.5%）。耐甲氧西林金黄色葡萄球菌（MRSA）是主要致病病原体。慢性透析组住院时间更长、住院死亡率更高、1年死亡率更高。与非透析组相比，住院死亡率的比值比为2.20。
该研究强调了慢性透析患者感染性脊椎间盘炎预后较差以及耐甲氧西林金黄色葡萄球菌感染频率较高。因此，对慢性透析患者感染性脊椎间盘炎的管理而言，保持高度警惕、及时识别并经验性覆盖MRSA非常重要。
