Lestin-Bernstein Franka, Tietke Marc, Briedigkeit Lutz, Heese Oliver
Department for Clinical Hygiene and Infectiology, HELIOS Clinics of Schwerin, Wismarsche Str. 393-397 19049, Schwerin, Germany.
Institute for Radiology and Neuroradiology, HELIOS Clinics of Schwerin, Schwerin, Germany.
J Med Microbiol. 2018 Jun;67(6):757-768. doi: 10.1099/jmm.0.000703.
Spondylodiscitis as a rare disease has increased in recent years; there are only a few recommendations regarding the diagnostics and treatment. The objective of this retrospective study was to characterise these patients and identify factors for a favourable healing process - with an emphasis on antibiotic therapy. Findings/treatment regimens for all patients with spondylodiscitis treated at a tertiary care hospital in 2012/2013 were recorded. The patients were classified into two groups, depending on the healing process. Fifty-seven patients met the clinical/radiological criteria for spondylodiscitis. The main symptom was massive back pain, combined with a moderate CRP elevation (median 96 mg l), and occasionally fever (39 %). CT-guided aspiration - in addition to blood cultures - improved the detection rate for the causative pathogen from 49 to 82 %. Thirty patients had a favourable clinical course; 25 had an unfavourable clinical course (prolonged clinical course, recurrence, death). Pathogen-specific antibiotic therapy had a decisive effect on the clinical course: initial high-dose intravenous therapy for at least 14 days was associated significantly more often with a favourable clinical course (90 vs 30 % after 24 months, <0.001). Fourteen days after the start of treatment, marked pain reduction and a CRP reduction of at least 50 % were good prognostic parameters and markers of effective antibiotic therapy. Pathogen detection and establishment of an optimal antibiotic regimen are cornerstones of successful conservative therapy for spondylodiscitis. Targeted initial intravenous therapy for at least 14 days with a bactericidal antibiotic leads to a better clinical course.
近年来，作为一种罕见病的脊椎椎间盘炎发病率有所上升；关于其诊断和治疗的建议很少。这项回顾性研究的目的是对这些患者进行特征描述，并确定有利于愈合过程的因素——重点是抗生素治疗。记录了2012/2013年在一家三级护理医院接受治疗的所有脊椎椎间盘炎患者的检查结果/治疗方案。根据愈合过程将患者分为两组。57名患者符合脊椎椎间盘炎的临床/放射学标准。主要症状是剧烈背痛，伴有CRP中度升高（中位数96mg/L），偶尔伴有发热（39%）。除血培养外，CT引导下穿刺将致病病原体的检出率从49%提高到了82%。30名患者临床病程良好；25名患者临床病程不佳（病程延长、复发、死亡）。病原体特异性抗生素治疗对临床病程有决定性影响：初始高剂量静脉治疗至少14天与更有利的临床病程显著相关（24个月后分别为90%和30%，P<0.001）。治疗开始14天后，疼痛明显减轻和CRP至少降低50%是良好的预后参数和有效抗生素治疗的标志。病原体检测和建立最佳抗生素治疗方案是脊椎椎间盘炎成功保守治疗的基石。使用杀菌性抗生素进行至少14天的靶向初始静脉治疗可带来更好的临床病程。
