Brooks Christopher Alan, Mahajan Sameer, Beresford Rohan, Damodaran Omprakash, Pope Raoul
Department of Neurosurgery, Concord Repatriation General Hospital, Concord, Australia.
Department of Microbiology and Infectious Diseases, Concord Repatriation General Hospital, Concord, Australia.
J Spine Surg. 2022 Mar;8(1):54-61. doi: 10.21037/jss-21-124.
Spondylodiscitis is an insidious and infectious pathology of the spinal column attributable to pathogenic micro-organisms and occurs in a variety of contexts. These micro-organisms can be inoculated surgically or can metastasise from distant sites of infection. species are important community-acquired and nosocomial pathogens but are uncommonly implicated in spinal infection. is more obscure than its generic relative and has only five times previously been reported in spondylodiscitis. It possesses the ability to acquire inducible and recombinant antibiotic resistance, especially in the hospital setting. We describe the case of an elderly man with complex urology and this rare sequela due to incomplete treatment of a urinary infection. He developed sepsis that recurred after incomplete antibiosis and seeded to his thoracic spine causing overt spondylodiscitis. The infection fulminated and his spinal lesion deteriorated into acute spinal cord compression with neurological compromise, requiring surgical decompression, fixation and long-term antibiotics. This is a sixth documented instance of a rare spinal bacterial infection. We describe the relevant microbiology and pathology, neurosurgical considerations, and general practice points for clinicians. Our report is a novel illustration of the potentially catastrophic consequences of inadequately treated urosepsis and is a stark reminder of the importance of antimicrobial stewardship.
脊椎椎间盘炎是一种由致病微生物引起的脊柱隐匿性感染性病变,可发生于多种情况下。这些微生物可通过手术接种,也可从远处感染部位转移而来。某些菌种是重要的社区获得性和医院内病原菌,但很少与脊柱感染有关。某菌种比其同类普通菌种更为隐匿,此前仅在脊椎椎间盘炎中报道过五次。它具有获得诱导性和重组抗生素耐药性的能力,尤其是在医院环境中。我们描述了一例患有复杂泌尿系统疾病的老年男性病例,该病例因泌尿系统感染治疗不彻底而出现这种罕见的后遗症。他发生了败血症,在抗生素治疗不彻底后复发,并播散至胸椎,导致明显的脊椎椎间盘炎。感染迅速发展,他的脊柱病变恶化为急性脊髓压迫并伴有神经功能损害,需要进行手术减压、固定和长期使用抗生素治疗。这是罕见的脊柱细菌感染的第六例有记录的病例。我们描述了相关的微生物学和病理学、神经外科考虑因素以及对临床医生的一般实践要点。我们的报告新颖地说明了治疗不充分的泌尿道败血症可能带来的灾难性后果,也强烈提醒了抗菌药物管理的重要性。