治疗失败的椎体骨髓炎：都是金黄色葡萄球菌的问题吗？

Treatment Failure in Vertebral Osteomyelitis: Is it All About Staphylococcus aureus ?

机构信息

Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

出版信息

Spine (Phila Pa 1976). 2022 Oct 15;47(20):E607-E614. doi: 10.1097/BRS.0000000000004420. Epub 2022 Jul 15.

DOI:10.1097/BRS.0000000000004420

PMID:35867569

Abstract

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

The aim was to compare the influence of 2 common vertebral osteomyelitis (VO) causing pathogens on treatment failure within the first year of diagnosis.

SUMMARY OF BACKGROUND DATA

VO is mainly caused by Staphylococcus aureus (SA), while enterococci and streptococci (ENST) are also responsible for a significant proportion of VO, particularly in elderly patients. Data on VO caused by SA show a tendency for worse outcome, whereas data on VO caused by ENST are scarce. For this purpose, our study compares characteristics of patients with VO caused by SA or ENST in order to analyze risk factors for treatment failure.

METHODS

We conducted a retrospective monocentric study including VO patients from 2008 to 2020. Primary outcome was treatment failure defined as death or relapse within 1 year (T1). We compared patients diagnosed with VO caused by Staphylococcus aureus including MRSA to patients diagnosed with VO caused by Enterococcus and Streptococcus species, which were combined into one group. Polymicrobial infections were excluded. We employed multiple logistic regression analysis to adjust for confounding. To account for moderation, the model was repeated with an included interaction term.

RESULTS

Data of 130 VO patients (SA=95; ENST=35) were available at T1. Treatment failure occurred in 37% of SA patients and 23% of ENST patients. On multivariate analysis SA [odds ratio (OR): 3.12; 95% confidence interval (CI): 1.09-10.53; P =0.046], Charlson comorbidity index (OR: 1.31; 95% CI: 1.11-1.58; P =0.002) and infectious endocarditis (IE; OR: 4.29; 95% CI: 1.23-15.96; P =0.024) were identified as independent risk factors for treatment failure.

CONCLUSION

In our cohort every third patient with VO caused by SA or ENST dies within 1 year. Our findings indicate that patients with VO caused by SA, concomitant IE and/or a high Charlson comorbidity index score may be at elevated risk for treatment failure. These findings can be used to individualize patient care and to direct clinical surveillance. This could include echocardiography evaluating for the presence of IE in patients with VO caused by gram-positive pathogens.

摘要

研究设计

回顾性队列研究。

目的

旨在比较两种常见的椎体骨髓炎（VO）病原体在诊断后第一年的治疗失败的影响。

背景资料概要

VO 主要由金黄色葡萄球菌（SA）引起，而肠球菌和链球菌（ENST）也占 VO 的很大比例，尤其是在老年患者中。关于由 SA 引起的 VO 的数据显示出预后较差的趋势，而关于由 ENST 引起的 VO 的数据则很少。为此，我们的研究比较了由 SA 或 ENST 引起的 VO 患者的特征，以分析治疗失败的危险因素。

方法

我们进行了一项回顾性单中心研究，纳入了 2008 年至 2020 年期间的 VO 患者。主要结局是定义为 1 年内死亡或复发的治疗失败（T1）。我们将诊断为由金黄色葡萄球菌引起的 VO 患者（包括耐甲氧西林金黄色葡萄球菌）与诊断为由肠球菌和链球菌引起的 VO 患者进行比较，后者被合并为一组。排除混合感染。我们采用多元逻辑回归分析来调整混杂因素。为了考虑调节作用，模型中重复包含一个交互项。

结果

在 T1 时，共有 130 例 VO 患者（SA=95；ENST=35）的数据可用。SA 患者中有 37%和 ENST 患者中有 23%发生治疗失败。多变量分析显示，SA[比值比（OR）：3.12；95%置信区间（CI）：1.09-10.53；P=0.046]、Charlson 合并症指数（OR：1.31；95%CI：1.11-1.58；P=0.002）和感染性心内膜炎（IE；OR：4.29；95%CI：1.23-15.96；P=0.024）是治疗失败的独立危险因素。

结论

在我们的队列中，每 3 例由 SA 或 ENST 引起的 VO 患者中就有 1 例在 1 年内死亡。我们的研究结果表明，由 SA 引起的 VO 患者、同时患有 IE 和/或 Charlson 合并症指数评分较高的患者可能有更高的治疗失败风险。这些发现可用于个体化患者护理和指导临床监测。这可能包括对革兰氏阳性病原体引起的 VO 患者进行超声心动图检查以评估 IE 的存在。