Nishizawa Mitsuhiro, Djurasovic Mladen, Glassman Steven D, Crawford Charles H, Dimar John R, Owens R Kirk, Mathew Justin, Kostic Benjamin, Carreon Leah Y
Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, United States of America; University of Louisville, Department of Orthopaedic Surgery, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, United States of America.
Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, United States of America.
Spine J. 2025 Jul 11. doi: 10.1016/j.spinee.2025.07.029.
Methicillin-resistant Staphylococcus aureus (MRSA) is 1 of the major causative organisms of spinal infections, and its incidence of spinal infection caused by MRSA has been increasing in recent years. However, limited studies have assessed surgical outcomes and complications focusing specifically on MRSA spinal infections.
To evaluate the characteristics, surgical outcomes, and complications of spinal infection caused by MRSA.
Retrospective observational cohort.
Patients who underwent surgery for spinal infection, including discitis, osteomyelitis, epidural abscess, and/or septic facet arthritis. Patients with a history of spine surgery within the preceding 90 days or culture-negative spondylodiscitis were excluded.
Recurrence and postoperative complications within 1 year METHODS: We retrospectively reviewed 205 patients who underwent surgery for spinal infection. Clinical characteristics and postoperative complications within 1 year were compared between patients with spinal infection caused by MRSA (MRSA) and those with infections caused by other organisms (Non-MRSA). Multiple logistic analysis was performed to determine independent factors associated with recurrence.
MRSA was identified in 89 patients (43%). Compared to Non-MRSA patients, MRSA patients had a significantly higher incidence of current smoking (57% vs. 40%, p=.021), intravenous drug use (49% vs. 33%, p=.021), thoracic spine involvement (43% vs. 28%, p=.039), epidural abscess (65% vs. 45%, p=.005), concomitant bone and joint infections (30% vs. 16%, p=.027), and positive blood culture (63% vs. 46%, p=.017). They also had significantly higher rates of readmission after 30 days postoperatively (48% vs. 34%, p=.044) and recurrence (20% vs. 7.8%, p=.012). MRSA was an independent risk factor for recurrence following surgical treatment of spinal infection (MRSA: OR 2.60, 95% CI 1.10-6.52, p=.033).
Spinal infections caused by MRSA were associated with a higher prevalence of current smoking, intravenous drug use, thoracic spine involvement, epidural abscesses, concomitant bone or joint infections, and bacteremia. Moreover, MRSA was identified as an independent risk factor for recurrence following surgical treatment of spinal infection.
耐甲氧西林金黄色葡萄球菌（MRSA）是脊柱感染的主要致病微生物之一，近年来其所致脊柱感染的发病率呈上升趋势。然而，专门针对MRSA脊柱感染的手术疗效和并发症的研究有限。
评估MRSA所致脊柱感染的特征、手术疗效及并发症。
回顾性观察队列研究。
因脊柱感染接受手术治疗的患者，包括椎间盘炎、骨髓炎、硬膜外脓肿和/或化脓性小关节关节炎。排除既往90天内有脊柱手术史或培养阴性的脊柱椎间盘炎患者。
1年内的复发情况和术后并发症
我们回顾性分析了205例因脊柱感染接受手术治疗的患者。比较了由MRSA引起的脊柱感染患者（MRSA组）和由其他微生物引起的感染患者（非MRSA组）的临床特征和术后1年内的并发症情况。进行多因素逻辑分析以确定与复发相关的独立因素。
89例患者（43%）检出MRSA。与非MRSA患者相比，MRSA患者当前吸烟率显著更高（57%对40%，p = 0.021）、静脉药物使用史比例更高（49%对33%，p = 0.021）、胸椎受累比例更高（43%对28%，p = 0.039）、硬膜外脓肿比例更高（65%对45%，p = 0.005）、合并骨和关节感染比例更高（30%对16%，p = 0.027）以及血培养阳性比例更高（63%对46%，p = 0.017）。他们术后30天后的再入院率（48%对34%，p = 0.044）和复发率（20%对7.8%，p = 0.012）也显著更高。MRSA是脊柱感染手术治疗后复发的独立危险因素（MRSA：比值比2.60，95%置信区间1.10 - 6.52，p = 0.033）。
MRSA所致脊柱感染与当前吸烟、静脉药物使用、胸椎受累、硬膜外脓肿、合并骨或关节感染以及菌血症的较高患病率相关。此外，MRSA被确定为脊柱感染手术治疗后复发的独立危险因素。
