Nishizawa Mitsuhiro, Djurasovic Mladen, Glassman Steven D, Dimar John R, Crawford Charles H, Gum Jeffrey L, Owens R Kirk, Mathew Justin, Kostic Benjamin A, Carreon Leah Y
Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA; Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA.
Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
Spine J. 2025 Jul 8. doi: 10.1016/j.spinee.2025.07.025.
Intravenous drug use (IVDU) is a significant risk factor for spinal infections. However, spinal infection in IVDU patients compared to Non-IVDU remains poorly described in the literature.
To assess the characteristics, surgical outcomes, and complications of spinal infections in patients IVDU and Non-IVDU patients.
Retrospective observational cohort.
Consecutive series of patients who underwent surgery for spinal infections, including spondylodiscitis, epidural abscess, and facet joint septic arthritis at a single multisurgeon tertiary institution.
postoperative complications, causative pathogens, recurrence rates.
We retrospectively reviewed consecutive patients who underwent surgery for spinal infections, including spondylodiscitis, epidural abscess, and facet joint septic arthritis. Demographics, comorbidities, causative pathogens, and postoperative complications were compared between IVDU and Non-IVDU patients.
Among 255 patients, 88 (35%) were IVDU. Compared to Non-IVDU patients, they were significantly younger (47.2±10.3 vs. 59.6±13.4 years, p<.001) and had a lower BMI (26.6±5.9 vs. 29.7±8.7, p=.001) but a lower incidence of diabetes (16% vs. 52%, p<.001), steroid use (0% vs. 9%, p=.002), and chronic kidney disease (9% vs. 29%, p≤.001). While the lumbar spine was the most commonly affected region, followed by the thoracic spine, cervical spine infection was significantly more frequent in IVDU patients (19% vs. 8%, p=.013). Additionally, concomitant endovascular infections were more commonly observed in IVDU patients (19% vs. 8%, p=.015). As causative pathogens, MRSA and Serratia were significantly more prevalent in IVDU patients (MRSA; 50% vs. 27%, p<.001, Serratia; 10% vs. 0%, p<.001). IVDU patients had significantly higher rates of readmission (67% vs. 46%, p=.002) and complication rates within 1 year, including spinal infection recurrence (20% vs. 6%, p=.001), endovascular infections (17% vs. 5%, p=.006), and uncontrolled pain (26% vs. 0%, p<.001). IVDU (OR=2.94, 95% CI: 1.24-7.24, p=.016) was independently associated with treatment failure, defined as recurrence or mortality.
Compared to Non-IVDU patients, IVDU patients had higher rates of cervical spine involvement, concomitant endovascular endocarditis, and MRSA and Serratia infection, as well as increased readmissions and complications, including recurrence, endovascular infections, and uncontrolled pain.
静脉药物使用（IVDU）是脊柱感染的一个重要危险因素。然而，与非静脉药物使用患者相比，静脉药物使用患者的脊柱感染在文献中描述较少。
评估静脉药物使用患者和非静脉药物使用患者脊柱感染的特征、手术结果及并发症。
回顾性观察队列研究。
在一家多外科医生的三级医疗机构，对连续一系列因脊柱感染接受手术的患者进行研究，包括脊椎椎间盘炎、硬膜外脓肿和小关节化脓性关节炎。
术后并发症、致病病原体、复发率。
我们回顾性分析了因脊柱感染接受手术的连续患者，包括脊椎椎间盘炎、硬膜外脓肿和小关节化脓性关节炎。比较了静脉药物使用患者和非静脉药物使用患者的人口统计学、合并症、致病病原体及术后并发症。
255例患者中，88例（35%）为静脉药物使用患者。与非静脉药物使用患者相比，他们明显更年轻（47.2±10.3岁对59.6±13.4岁，p<0.001），体重指数更低（26.6±5.9对29.7±8.7，p = 0.001），但糖尿病发病率更低（16%对52%，p<0.001），类固醇使用情况（0%对9%，p = 0.002）及慢性肾病发病率更低（9%对29%，p≤0.001）。虽然腰椎是最常受累部位，其次是胸椎，但颈椎感染在静脉药物使用患者中明显更常见（19%对8%，p = 0.013）。此外，静脉药物使用患者中更常观察到合并血管内感染（19%对8%，p = 0.015）。作为致病病原体，耐甲氧西林金黄色葡萄球菌（MRSA）和沙雷氏菌在静脉药物使用患者中明显更普遍（MRSA：50%对27%，p<0.001，沙雷氏菌：10%对0%，p<0.001）。静脉药物使用患者再入院率（67%对46%，p = 0.002）及1年内并发症发生率明显更高，包括脊柱感染复发（20%对6%，p = 0.001）、血管内感染（17%对5%，p = 0.006）及疼痛控制不佳（26%对无，p<0.001）。静脉药物使用（比值比=2.94，95%置信区间：1.24 - 7.24，p = 0.016）与治疗失败独立相关，治疗失败定义为复发或死亡。
与非静脉药物使用患者相比，静脉药物使用患者颈椎受累、合并血管内感染、MRSA和沙雷氏菌感染的发生率更高，并增加了再入院率和并发症，包括复发、血管内感染及疼痛控制不佳。
