Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Int Orthop. 2024 Jan;48(1):5-20. doi: 10.1007/s00264-023-05989-2. Epub 2023 Oct 4.
Knowledge of Candida spondylodiscitis is limited to case reports and smaller case series. Controversy remains on the most effective diagnostical and therapeutical steps once Candida is suspected. This systematic review summarized all cases of Candida spondylodiscitis reported to date concerning baseline demographics, symptoms, treatment, and prognostic factors.
A PRISMA-based search of PubMed, Web of Science, Embase, Scopus, and OVID Medline was performed from database inception to November 30, 2022. Reported cases of Candida spondylodiscitis were included regardless of Candida strain or spinal levels involved. Based on these criteria, 656 studies were analyzed and 72 included for analysis. Kaplan-Meier curves, Fisher's exact, and Wilcoxon's rank sum tests were performed.
In total, 89 patients (67% males) treated for Candida spondylodiscitis were included. Median age was 61 years, 23% were immunocompromised, and 15% IV drug users. Median length of antifungal treatment was six months, and fluconazole (68%) most commonly used. Thirteen percent underwent debridement, 34% discectomy with and 21% without additional instrumentation. Median follow-up was 12 months. The two year survivorship free of death was 80%. The two year survivorship free of revision was 94%. Younger age (p = 0.042) and longer length of antifungal treatment (p = 0.061) were predictive of survival.
Most patients affected by Candida spondylodiscitis were males in their sixties, with one in four being immunocompromised. While one in five patients died within two years of diagnosis, younger age and prolonged antifungal treatment might play a protective role.
关于念珠菌性脊椎骨髓炎的知识仅限于病例报告和较小的病例系列。一旦怀疑念珠菌感染，最有效的诊断和治疗步骤仍存在争议。本系统综述总结了迄今为止报告的所有念珠菌性脊椎骨髓炎病例，涉及基线人口统计学、症状、治疗和预后因素。
基于 PRISMA 的搜索策略，对 PubMed、Web of Science、Embase、Scopus 和 OVID Medline 进行了检索，检索时间从数据库建立到 2022 年 11 月 30 日。纳入了无论念珠菌菌株或涉及的脊柱水平如何的念珠菌性脊椎骨髓炎病例。根据这些标准，分析了 656 项研究，并纳入了 72 项进行分析。进行了 Kaplan-Meier 曲线、Fisher 精确检验和 Wilcoxon 秩和检验。
共纳入 89 例（67%为男性）接受念珠菌性脊椎骨髓炎治疗的患者。中位年龄为 61 岁，23%为免疫功能低下，15%为静脉吸毒者。抗真菌治疗的中位时间为 6 个月，氟康唑（68%）最常用。13%进行了清创术，34%进行了椎间盘切除术，其中 21%未进行额外的器械固定。中位随访时间为 12 个月。两年内无死亡的生存率为 80%。两年内无翻修的生存率为 94%。年龄较小（p=0.042）和抗真菌治疗时间较长（p=0.061）与生存率相关。
大多数受念珠菌性脊椎骨髓炎影响的患者为 60 多岁的男性，四分之一的患者免疫功能低下。尽管五分之一的患者在诊断后两年内死亡，但年龄较小和延长抗真菌治疗可能起到保护作用。
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