Saad Berreta Rodrigo, Zhang Helen, Alsoof Daniel, McDonald Christopher L, Diebo Bassel G, Kuris Eren, Daniels Alan H
1The Warren Alpert Medical School of Brown University, Providence; and.
2Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
J Neurosurg Spine. 2023 Mar 17:1-6. doi: 10.3171/2023.2.SPINE221353.
Spinal osteomyelitis and spondylodiscitis (SD) are infections of the vertebral body and disc, respectively, with more than 50% associated with Staphylococcus aureus. Methicillin-resistant S. aureus (MRSA) has become a pathogen of interest in cases of SD due to increasing prevalence. The purpose of this investigation was to characterize the current epidemiological and microbiological landscape in SD cases, in addition to medical and surgical challenges in treating these infections.
The PearlDiver Mariner database was queried for ICD-10 codes to identify cases of SD from 2015 to 2021. The initial cohort was stratified by offending pathogens, including methicillin-sensitive S. aureus (MSSA) and MRSA. Primary outcome measures included epidemiological trends, demographics, and rates of surgical management. Secondary outcomes included length of hospital stay, rate of reoperation, and complications associated with surgical cases. Multivariable logistic regression was used to control for age, gender, region, and Charlson Comorbidity Index (CCI).
Nine thousand nine hundred eighty-three patients met the inclusion criteria and were retained for this study. Approximately half (45.5%) of SD cases resulting from S. aureus infections each year were resistant to beta-lactam antibiotics. The proportion of cases that were managed surgically was 31.02%. Among the cases that involved surgical intervention, 21.83% underwent revision operations within 30 days of the original procedure and 37.29% of cases returned to the operating room within 1 year. Substance abuse, specifically alcohol, tobacco, and drug use, were strong predictors for surgical intervention in cases of SD (all p < 0.001), in addition to obesity (p = 0.002), liver disease (p < 0.001), and valvular disease (p = 0.025). After adjusting for age, gender, region, and CCI, cases of MRSA were more likely to undergo surgical management (OR 1.19, p = 0.003). MRSA SD also exhibited higher rates of reoperation within 6 months (OR 1.29, p = 0.001) and 1 year (OR 1.36, p < 0.001). Surgical cases resulting from MRSA infections also exhibited higher morbidity and significant rates of transfusion (OR 1.47, p = 0.030), acute kidney injury (OR 1.35, p = 0.001), pulmonary embolism (OR 1.44, p = 0.030), pneumonia (OR 1.49, p = 0.002), and urinary tract infection (OR 1.45, p = 0.002) compared with MSSA SD infections.
More than 45% of cases of S. aureus SD in the US are resistant to beta-lactam antibiotics, presenting obstacles in treatment. Cases of MRSA SD are more likely to be managed surgically and have higher rates of complications and reoperations. Early detection and prompt operative management are imperative to reduce the risk of complications.
脊柱骨髓炎和椎间盘炎（SD）分别是椎体和椎间盘的感染，超过50%与金黄色葡萄球菌有关。由于其患病率不断上升，耐甲氧西林金黄色葡萄球菌（MRSA）已成为SD病例中备受关注的病原体。本研究的目的是描述SD病例当前的流行病学和微生物学情况，以及治疗这些感染时面临的医学和外科挑战。
查询PearlDiver Mariner数据库中的ICD - 10编码，以识别2015年至2021年的SD病例。初始队列按致病病原体分层，包括甲氧西林敏感金黄色葡萄球菌（MSSA）和MRSA。主要结局指标包括流行病学趋势、人口统计学特征和手术治疗率。次要结局包括住院时间、再次手术率以及与手术病例相关的并发症。采用多变量逻辑回归来控制年龄、性别、地区和查尔森合并症指数（CCI）。
9983例患者符合纳入标准并被纳入本研究。每年由金黄色葡萄球菌感染导致的SD病例中，约一半（45.5%）对β - 内酰胺类抗生素耐药。接受手术治疗的病例比例为31.02%。在涉及手术干预的病例中，21.83%在初次手术后30天内接受了翻修手术，37.29%的病例在1年内再次接受手术。药物滥用，特别是酒精、烟草和药物使用，除肥胖（p = 0.002）、肝病（p < 0.001）和瓣膜病（p = 0.025）外，是SD病例手术干预的强预测因素（所有p < 0.001）。在调整年龄、性别、地区和CCI后，MRSA病例更有可能接受手术治疗（OR 1.19，p = 0.003）。MRSA SD在6个月内（OR 1.29，p = 0.001）和1年内（OR 1.36，p < 0.001）的再次手术率也更高。与MSSA SD感染相比，MRSA感染导致的手术病例还表现出更高的发病率和显著的输血率（OR 1.47，p = 0.030）、急性肾损伤（OR 1.35，p = 0.001）、肺栓塞（OR 1.44，p = 0.030）、肺炎（OR 1.49，p = 0.002）和尿路感染（OR 1.45，p = 0.002）。
美国超过45%的金黄色葡萄球菌SD病例对β - 内酰胺类抗生素耐药，给治疗带来障碍。MRSA SD病例更有可能接受手术治疗，且并发症和再次手术率更高。早期检测和及时的手术管理对于降低并发症风险至关重要。
