Endo Kaori
Sapporo Tokusyukai Hospital, Sapporo, Hokkaido, Japan.
National Coalition of Independent Scholars, Battleboro, VT, United States of America.
PeerJ. 2024 Nov 26;12:e18432. doi: 10.7717/peerj.18432. eCollection 2024.
To investigate how risk factors and reduced spinal mobility contribute to spinal infections arising from methicillin-susceptible (MSSA) bacteremia, known for increased mortality and diagnostic difficulties, especially in patients with septic shock or coma.
This retrospective study divided MSSA bacteremia patients into three groups: spinal infections (Group A, = 14), non-spinal/implant infections (Group B, = 24), and implant-related infections (Group C, = 21). Analyses focused on demographics, medical history, laboratory inflammatory markers at antibiotic initiation, and spinal pathologies detected by CT. All results of the statistical analyses were significant at < 0.05. We employed multinomial univariable logistic regression and contingency table analysis to assess risk factors across three groups. Subsequently, binomial multivariable logistic regression was used to compare Group A against Groups B and C, successfully identifying significant predictors of spinal infection.
A lower incidence of diabetes ( = 0.029), higher C-reactive protein (CRP) levels at onset ( = 0.014), and the presence of diffuse idiopathic skeletal hyperostosis (diffuse idiopathic skeletal hyperostosis (DISH); = 0.022) were significantly associated with spinal infections in Group A. Furthermore, binomial analysis revealed DISH (Odds Ratio (OR) = 41.750; 95% Confidence Interval (CI) [1.86-939.0]; = 0.019), absence of diabetes (OR = 1.20, CI [1.01-1.43], = 0.038), elevated CRP (OR = 23.34, CI [1.13-483.4], = 0.042), and a lower day 3/day 1 white blood cell (WBC) ratio (OR = 0.964, CI [0.93-1.00], = 0.047) as risk factors when compared with other groups.
Spinal infection patients with MSSA bacteremia are less likely to have diabetes and more likely to have higher initial CRP levels and DISH. Notably, DISH might be emerging as a distinctive risk factor for spinal infection, underscoring its potential as a marker for clinical awareness.
探讨风险因素和脊柱活动度降低如何导致由甲氧西林敏感金黄色葡萄球菌（MSSA）菌血症引起的脊柱感染，这种感染死亡率高且诊断困难，尤其是在感染性休克或昏迷患者中。
这项回顾性研究将MSSA菌血症患者分为三组：脊柱感染组（A组，n = 14）、非脊柱/植入物感染组（B组，n = 24）和植入物相关感染组（C组，n = 21）。分析重点在于人口统计学、病史、抗生素起始使用时的实验室炎症标志物以及CT检测到的脊柱病变。所有统计分析结果在P < 0.05时具有显著性。我们采用多项单变量逻辑回归和列联表分析来评估三组中的风险因素。随后，使用二项多变量逻辑回归将A组与B组和C组进行比较，成功识别出脊柱感染的显著预测因素。
糖尿病发病率较低（P = 0.029）、发病时C反应蛋白（CRP）水平较高（P = 0.014）以及存在弥漫性特发性骨肥厚（DISH；P = 0.022）与A组的脊柱感染显著相关。此外，二项分析显示，与其他组相比，DISH（比值比（OR）= 41.750；95%置信区间（CI）[1.86 - 939.0]；P = 0.019）、无糖尿病（OR = 1.20，CI [1.01 - 1.43]，P = 0.038）、CRP升高（OR = 23.34，CI [1.13 - 483.4]，P = 0.042）以及第3天/第1天白细胞（WBC）比值较低（OR = 0.964，CI [0.93 - 1.00]，P = 0.047）为风险因素。
患有MSSA菌血症的脊柱感染患者患糖尿病的可能性较小，初始CRP水平较高和患DISH的可能性较大。值得注意的是，DISH可能正在成为脊柱感染的一个独特风险因素，凸显其作为临床关注指标的潜力。
