Corso F A, Shaul D B, Wolfe B M
Department of Surgery, University of California, Davis, USA.
JPEN J Parenter Enteral Nutr. 1995 Jul-Aug;19(4):291-5. doi: 10.1177/0148607195019004291.
Osteomyelitis of the spine is a well-recognized delayed manifestation of septicemia but has not been recognized as a complication of total parenteral nutrition. We report five cases of spinal osteomyelitis that were clinically recognized 1 to 13 months after total parenteral nutrition catheter-induced septicemia. Radiographic evidence of osteomyelitis was seen in all five patients. In three patients, culture of bony aspirates was positive for the same organism as from the blood. In one case, the diagnosis was established by histology, and in one the diagnosis was based on radiographic and radionuclide evidence of osteomyelitis. The organism responsible was Staphylococcus aureus in two cases, Candida albicans in another two cases and C tropicalis in one case. The septic episode that preceded osteomyelitis was treated with systemic antibiotics and catheter removal in four patients, and antibiotics without catheter removal in one patient. Nevertheless, osteomyelitis occurred, requiring bracing or operative debridement as well as prolonged antibiotic therapy. Spinal osteomyelitis may occur as a delayed manifestation of total parenteral nutrition catheter-induced septicemia. Prompt and effective treatment of septicemia is indicated but may not always be sufficient. Clinical suspicion is the key to the correct and early diagnosis of osteomyelitis and therefore to adequate treatment.
脊柱骨髓炎是败血症一种公认的迟发表现，但尚未被视为全胃肠外营养的并发症。我们报告了5例脊柱骨髓炎病例，这些病例在全胃肠外营养导管引起败血症后1至13个月被临床确诊。所有5例患者均有骨髓炎的影像学证据。3例患者骨穿刺培养出的病原体与血培养的病原体相同。1例通过组织学确诊，1例根据骨髓炎的影像学和放射性核素证据确诊。致病病原体2例为金黄色葡萄球菌，另2例为白色念珠菌，1例为热带念珠菌。4例骨髓炎之前的败血症发作患者接受了全身抗生素治疗并拔除了导管，1例患者仅接受了抗生素治疗而未拔除导管。尽管如此，仍发生了骨髓炎，需要进行支具固定或手术清创以及长期抗生素治疗。脊柱骨髓炎可能是全胃肠外营养导管引起败血症的迟发表现。败血症需及时有效治疗，但可能并不总是足够的。临床怀疑是正确早期诊断骨髓炎并因此进行充分治疗的关键。
