椎间盘低度细菌和病毒感染的频率和特征：一项前瞻性、观察性研究。
Frequency and characteristics of bacterial and viral low-grade infections of the intervertebral discs: a prospective, observational study.
机构信息
Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria.
Department of Internal Medicine, Kepler University Hospital, Johannes Kepler University, Wagner-Jauregg Weg 15, 4020, Linz, Austria.
出版信息
J Orthop Traumatol. 2022 Mar 18;23(1):15. doi: 10.1186/s10195-022-00633-y.
STUDY DESIGN
Monocentric, prospective, observational study.
OBJECTIVE
The clinical relevance of bacterial colonization of intervertebral discs is controversial. This study aimed to determine a possible relationship between bacterial and viral colonization and low-grade infection of the discs.
METHODS
We investigated 447 disc samples from 392 patients. Microbiological culture was used to examine the samples for bacterial growth, polymerase chain reaction (PCR) was used for detection of herpes simplex virus types 1 and 2 (HSV-1, HSV-2) and Cytomegalovirus (CMV), and histopathological analysis was used to detect signs of inflammation. The results were compared between subgroups organized according to gender, age, location of the samples, surgical approach, preoperative C-reactive protein (CRP), preoperative and 6 months postoperative Oswestry Disability Index (ODI) and Neck Disability Index (NDI), and Modic changes (MC) of the corresponding endplates. Also, we assessed the occurrence of postoperative infections within 6 months.
RESULTS
Microbiological culture was positive in 38.78% of the analyzed intervertebral discs. Altogether, 180 bacteria were isolated. Coagulase-negative staphylococci (CONS) (23.41%) and Cutibacterium acnes (18.05%) were the most frequently detected microorganisms. None of HSV-1, HSV-2, or CMV were detected. Male patients (p = 0.00036) and cervical segments (p = 0.00001) showed higher rates of positive culture results. Ventral surgical approaches ( p < 0.001) and Type 2 MC (p = 0.0127) were significantly associated with a positive microbiological result ( p< 0.001). Neither pre- nor postoperative ODI and NDI are associated with positive culture results. In 4 (1.02%) patients, postoperative spondylodiscitis occurred.
CONCLUSIONS
With 447 segments from 392 patients, we present one of the largest studies to date. While disc degeneration caused by HSV-1, HSV-2, and CMV seems unlikely, we found positive microbiological culture results in 38.78% of all discs. The role of local skin flora and sample contamination should be the focus of further investigations.
LEVEL OF EVIDENCE
III.
TRIAL REGISTRATION
The study was registered at ClinicalTrials.gov (ID: NCT04712487, https://www.
CLINICALTRIALS
gov/ct2/show/study/NCT04712487 ).
研究设计
单中心、前瞻性、观察性研究。
目的
椎间盘细菌定植的临床意义存在争议。本研究旨在确定椎间盘低度感染与细菌和病毒定植之间的可能关系。
方法
我们研究了 392 名患者的 447 个椎间盘样本。微生物培养用于检测细菌生长，聚合酶链反应（PCR）用于检测单纯疱疹病毒 1 型和 2 型（HSV-1、HSV-2）和巨细胞病毒（CMV），组织病理学分析用于检测炎症迹象。根据性别、年龄、样本位置、手术方式、术前 C 反应蛋白（CRP）、术前和 6 个月后的 Oswestry 残疾指数（ODI）和颈部残疾指数（NDI）以及相应终板的 Modic 改变（MC）对亚组进行分组，比较结果。此外，我们还评估了术后 6 个月内的感染发生情况。
结果
分析的椎间盘中有 38.78%的微生物培养呈阳性。共分离出 180 株细菌。凝固酶阴性葡萄球菌（CONS）（23.41%）和痤疮丙酸杆菌（18.05%）是最常检测到的微生物。未检测到 HSV-1、HSV-2 或 CMV。男性患者（p=0.00036）和颈椎节段（p=0.00001）的阳性培养率较高。腹侧手术入路（p<0.001）和 2 型 MC（p=0.0127）与微生物阳性结果显著相关（p<0.001）。术前和术后的 ODI 和 NDI 均与阳性培养结果无关。4 名（1.02%）患者发生术后脊椎炎。
结论
本研究共纳入 392 名患者的 447 个节段，是迄今为止最大的研究之一。虽然 HSV-1、HSV-2 和 CMV 引起的椎间盘退变似乎不太可能，但我们发现所有椎间盘的微生物培养阳性率为 38.78%。局部皮肤菌群和样本污染的作用应成为进一步研究的重点。
证据水平
III。
试验注册
该研究在 ClinicalTrials.gov 注册（ID：NCT04712487，https://www.clinicaltrials.gov/ct2/show/study/NCT04712487）。
Zotero 插件