Swedish Neuroscience Institute, Seattle, WA, USA.
Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Neurosurg Rev. 2021 Aug;44(4):2111-2118. doi: 10.1007/s10143-020-01376-2. Epub 2020 Aug 27.
Vertebral osteomyelitis (VO) is a severe infection of the vertebral body and the adjacent disc space, where Staphylococcus aureus is most commonly isolated. The objective of this retrospective study was to determine risk factors for and compare outcome differences between de novo methicillin-resistant Staphylococcus aureus (MRSA) VO and methicillin-sensitive Staphylococcus aureus (MSSA) VO. A retrospective cohort study was performed by review of the electronic medical records of 4541 consecutive spine surgery patients. Among these 37 underwent surgical treatment of de novo MRSA and MSSA spinal infections. Patient demographics, pre- and postoperative neurological status (ASIA impairment score), surgical treatment, inflammatory laboratory values, nutritional status, comorbidities, antibiotics, hospital stay, ICU stay, reoperation, readmission, and complications were collected. A minimum follow-up (FU) of 12 months was required. Among the 37 patients with de novo VO, 19 were MRSA and 18 were MSSA. Mean age was 52.4 and 52.9 years in the MRSA and MSSA groups, respectively. Neurological deficits were found in 53% of patients with MRSA infection and in 17% of the patients with MSSA infection, which was statistically significant (p < 0.05). Chronic renal insufficiency and malnutrition were found to be significant risk factors for MRSA VO. Preoperative albumin was significantly lower in the MRSA group (p < 0.05). Patients suffering from spinal infection with chronic renal insufficiency and malnutrition should be watched more carefully for MRSA. The MRSA group did not show a significant difference with regard to final clinical outcome despite more severe presentation.
椎体骨髓炎（VO）是一种严重的椎体及相邻椎间盘感染，其中金黄色葡萄球菌最常被分离出来。本回顾性研究的目的是确定新发耐甲氧西林金黄色葡萄球菌（MRSA）VO 和甲氧西林敏感金黄色葡萄球菌（MSSA）VO 的危险因素，并比较两者的结果差异。通过回顾性分析 4541 例连续脊柱手术患者的电子病历，进行回顾性队列研究。其中 37 例患者接受了新发 MRSA 和 MSSA 脊柱感染的手术治疗。收集患者的人口统计学、术前和术后神经状态（ASIA 损伤评分）、手术治疗、炎症实验室值、营养状况、合并症、抗生素、住院时间、ICU 住院时间、再次手术、再次入院和并发症等数据。要求最低随访（FU）时间为 12 个月。在 37 例新发 VO 患者中，19 例为 MRSA，18 例为 MSSA。MRSA 组和 MSSA 组患者的平均年龄分别为 52.4 岁和 52.9 岁。MRSA 感染患者中有 53%存在神经功能缺损，而 MSSA 感染患者中有 17%存在神经功能缺损，这具有统计学意义（p<0.05）。慢性肾功能不全和营养不良被认为是 MRSA VO 的显著危险因素。MRSA 组患者术前白蛋白显著降低（p<0.05）。患有慢性肾功能不全和营养不良的脊柱感染患者应更加密切关注 MRSA。尽管 MRSA 组患者的临床表现更为严重，但最终临床结局无显著差异。
