Pralea Alexander, Has Phinnara, Auld Dianne, Mermel Leonard A
Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Biostatistics, Epidemiology, and Research Design, Lifespan Healthcare System, Providence, Rhode Island, USA.
Open Forum Infect Dis. 2024 Sep 28;11(10):ofae553. doi: 10.1093/ofid/ofae553. eCollection 2024 Oct.
The incidence of spine infections has increased due to the surge in injection drug use driven by the opioid epidemic. Few recent studies have evaluated the microbiology of spinal epidural infections among people who inject drugs compared to the microbiology of such infections among the general population.
We performed a retrospective chart review to identify patients with a spinal epidural abscess or phlegmon unrelated to recent spine surgery between 2015 and 2023.
Of 346 initial records, 277 met inclusion criteria for demographic analyses. Of the 229 patients with microbiologic results, details regarding possible drug use were available in 227 patients. Patients with no documented history of drug use were categorized as non-PWUD, while patients who use drugs (PWUD) were separated based on whether drug use was active or not. Patients with prior histories of injection or noninjection drug use were categorized as nonactive PWUD, while those with injection or snorting drug use reported in the past 3 months were categorized as active PWUD. Thirty-nine percent of patients with spinal epidural infection had substance use disorder. Most patients with monomicrobial cultures were infected with gram-positive, aerobic bacteria (86%). Active PWUD were more likely to have methicillin-resistant compared to non-PWUD (36% vs 13%, respectively, = .002). Nonactive PWUD were more likely to have non- gram-negative bacterial infections than non-PWUD (18% and 4.4%, respectively, = .01).
More than 1 in 3 patients with a spinal epidural infection unrelated to recent surgery had substance use disorder. These patients are more likely to have infections due to MRSA and gram-negative bacteria other than such as .
由于阿片类药物流行导致注射吸毒激增，脊柱感染的发病率有所上升。与普通人群相比，近期很少有研究评估注射吸毒者脊柱硬膜外感染的微生物学情况。
我们进行了一项回顾性病历审查，以确定2015年至2023年间患有与近期脊柱手术无关的脊柱硬膜外脓肿或蜂窝织炎的患者。
在346份初始记录中，277份符合人口统计学分析的纳入标准。在229例有微生物学结果的患者中，227例有关于可能吸毒情况的详细信息。无吸毒记录的患者被归类为非注射吸毒者，而吸毒患者则根据吸毒是否活跃进行分类。有注射或非注射吸毒既往史的患者被归类为非活跃注射吸毒者，而在过去3个月内有注射或吸食毒品报告的患者被归类为活跃注射吸毒者。39%的脊柱硬膜外感染患者患有物质使用障碍。大多数单一微生物培养的患者感染的是革兰氏阳性需氧菌（86%）。与非注射吸毒者相比，活跃注射吸毒者更有可能感染耐甲氧西林菌（分别为36%和13%，P = 0.002）。非活跃注射吸毒者比非注射吸毒者更有可能感染非革兰氏阴性细菌（分别为18%和4.4%，P = 0.01）。
在与近期手术无关的脊柱硬膜外感染患者中，超过三分之一患有物质使用障碍。这些患者更有可能感染耐甲氧西林金黄色葡萄球菌和除大肠杆菌等革兰氏阴性细菌以外的其他细菌。
