Qu Changpeng, Wei Haixin, Zhang Hao, Lian Zheng, Lu Hui, Han Shuo
Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
Front Cell Infect Microbiol. 2025 Jan 27;15:1540970. doi: 10.3389/fcimb.2025.1540970. eCollection 2025.
Culture-negative spinal infections after prophylactic antibiotic use in percutaneous endoscopic decompression are rare, and diagnostic difficulties and the risk of antibiotic-resistant infections complicate treatment. This study retrospectively analyzed the medical records of culture-negative patients following percutaneous endoscopic surgery to identify risk factors influencing antimicrobial therapy and provide insights for clinical management.
Data were retrospectively collected from patients who underwent lumbar percutaneous endoscopic decompression at the Affiliated Hospital of Qingdao University between January 2014 and June 2023. The patients' medical records were reviewed. Patient demographics, hidden blood loss, daily blood glucose control, and maximum temperature during treatment were recorded as potential risk factors. C-reactive protein, procalcitonin, white blood cells, erythrocyte sedimentation rate, and the duration of antibiotic treatment were used as indicators of infection treatment. The impact of these risk factors on infection was then analyzed.
The results showed that blood glucose control was strongly correlated with the severity of infection (Beta = 0.60, P = 0.00), strongly correlated with short-term treatment effectiveness (Beta = 0.65, P = 0.00), and moderately correlated with the duration of antibiotic treatment (Beta = 0.41, P = 0.01). Hidden blood loss was moderately correlated with the severity of infection (Partial-R = 0.49, P = 0.00) and moderately correlated with the duration of antibiotic treatment (Partial-R = 0.48, P = 0.00). Hidden blood loss index was moderately correlated with the duration of antibiotic treatment (Partial-R = 0.50, P = 0.00). Female was a favorable factor to shorten the duration of antibiotic treatment (Beta = -0.25, P = 0.01), and higher maximum temperature during infection may indicate a longer duration of antibiotic treatment (Beta = 0.28, P = 0.02).
Our findings suggest that healthy blood glucose levels, a lower hidden blood loss and hidden blood loss index might help reduce the duration of antibiotic use after infection. Effective hemostasis during surgery to reduce hidden blood loss and good preoperative blood glucose control indicators are both beneficial measures for infection treatment.
在经皮内镜减压术中预防性使用抗生素后发生培养阴性的脊柱感染较为罕见，诊断困难以及抗生素耐药感染的风险使治疗变得复杂。本研究回顾性分析了经皮内镜手术后培养阴性患者的病历，以确定影响抗菌治疗的危险因素，并为临床管理提供见解。
回顾性收集2014年1月至2023年6月在青岛大学附属医院接受腰椎经皮内镜减压术患者的数据。查阅患者病历。记录患者人口统计学资料、隐性失血、每日血糖控制情况以及治疗期间的最高体温作为潜在危险因素。将C反应蛋白、降钙素原、白细胞、红细胞沉降率以及抗生素治疗持续时间用作感染治疗指标。然后分析这些危险因素对感染的影响。
结果显示，血糖控制与感染严重程度密切相关（β = 0.60，P = 0.00），与短期治疗效果密切相关（β = 0.65，P = 0.00），与抗生素治疗持续时间中度相关（β = 0.41，P = 0.01）。隐性失血与感染严重程度中度相关（偏相关系数 = 0.49，P = 0.00），与抗生素治疗持续时间中度相关（偏相关系数 = 0.48，P = 0.00）。隐性失血指数与抗生素治疗持续时间中度相关（偏相关系数 = 0.50，P = 0.00）。女性是缩短抗生素治疗持续时间的有利因素（β = -0.25，P = 0.01），感染期间较高的最高体温可能表明抗生素治疗持续时间较长（β = 0.28，P = 0.02）。
我们的研究结果表明，健康的血糖水平、较低的隐性失血和隐性失血指数可能有助于缩短感染后抗生素使用时间。手术中有效止血以减少隐性失血以及良好的术前血糖控制指标都是感染治疗的有益措施。
