Department of Orthopedics, Yenepoya Medical College, Mangalore, Karnataka, India.
Department of Orthopedics, Kanachur Medical College, Mangalore, Karnataka, India.
Indian J Tuberc. 2020 Oct;67(4):509-514. doi: 10.1016/j.ijtb.2020.07.002. Epub 2020 Jul 13.
In Indian subcontinent where tuberculosis is endemic, the spinal infection was thought to be due to mycobacterium tuberculosis in most of the cases. Hence there is a practice of treating these patients with empirical antitubercular treatment. However, recent guidelines advice biopsy and tissue diagnosis before starting antibiotics.
Our retrospective study analyses the role of biopsy in establishing the microbiological diagnosis and thus identifying the incidence of pyogenic and tubercular spondylodiscitis presented to a tertiary care centre.
All patients who were diagnosed as spondylodiscitis by clinical and radiological criteria and who underwent biopsy were included in the study and data was retrieved from medical records and PACS. Criteria for tubercular spondylodiscitis included presence of mycobacterium tuberculosis either in smear/gene Xpert, or histopathological evidence of tuberculosis. Organism isolation other than MTB or absence of tubercular granuloma and response to antibiotics were considered as non-tubercular aetiology.
Our study achieved 84% (n-63) accuracy for first biopsy and 34 patients (53.96%) were diagnosed as pyogenic spondylodiscitis. Organisms were isolated in 11 cases (32%) of pyogenic spondylodiscitis and tubercular bacilli in 17 cases (65%) of tubercular spondylodiscitis. Aspiration of pus yielded better isolation of organisms (P < 0.001) in pyogenic spondylodiscitis. 11% of cases showed drug resistant tuberculosis.
We conclude that there is an increasing trend of pyogenous spondylodiscitis compared to tubercular spondylodiscitis in patients presenting to tertiary care centre, hence biopsy is essential to start antimicrobials.
在结核病流行的印度次大陆，大多数脊柱感染被认为是由结核分枝杆菌引起的。因此，这些患者通常接受经验性抗结核治疗。然而，最近的指南建议在开始使用抗生素之前进行活检和组织诊断。
我们的回顾性研究分析了活检在确定微生物诊断中的作用，从而确定三级保健中心就诊的化脓性和结核性脊椎骨髓炎的发生率。
所有通过临床和影像学标准诊断为脊椎骨髓炎且接受活检的患者均纳入研究，并从病历和 PACS 中检索数据。结核性脊椎骨髓炎的标准包括在涂片/基因 Xpert 中存在结核分枝杆菌，或组织病理学有结核病证据。除结核分枝杆菌以外的病原体分离或无结核性肉芽肿以及对抗生素的反应被认为是非结核性病因。
我们的研究首次活检的准确率为 84%（n=63），34 例（53.96%）被诊断为化脓性脊椎骨髓炎。11 例（32%）化脓性脊椎骨髓炎患者分离出病原体，17 例（65%）结核性脊椎骨髓炎患者分离出结核杆菌。在化脓性脊椎骨髓炎中，脓液抽吸可更好地分离病原体（P<0.001）。11%的病例显示耐多药结核病。
我们的结论是，与三级保健中心就诊的患者相比，化脓性脊椎骨髓炎的发病率呈上升趋势，因此活检对于开始使用抗生素至关重要。
