Jensen A G, Espersen F, Skinhøj P, Frimodt-Møller N
Sector for Microbiology, Statens Serum Institut, Copenhagen, Denmark.
Arch Intern Med. 1998 Mar 9;158(5):509-17. doi: 10.1001/archinte.158.5.509.
The incidence of hematogenous Staphylococcus aureus osteomyelitis of the vertebral column is rapidly increasing and few studies dealing with the diagnosis, treatment, and outcome of this severe disease are available.
Based on a nationwide registration, the clinical and bacteriological data were reviewed from 133 cases with a positive blood culture for S aureus and symptoms of vertebral osteomyelitis in Denmark for the period 1980 to 1990.
The 133 cases of vertebral S aureus osteomyelitis reviewed were mainly community-acquired infections (82%) in older patients (median age, 65 years) and often occurred with underlying diseases. Both symptoms and laboratory values were relatively unspecific. Bone scan methods proved to be more optimal for diagnosis of vertebral S aureus osteomyelitis in the early stages compared with conventional radiography that proved a lack of consistency in the formative stages. The infection was mostly (70%) localized in the lower part of the column. The recurrence rate and rate of therapeutic failure depended on the duration and dosage of penicillinase-stable penicillins, respectively. Patients treated with fusidic acid in addition to penicillinase-stable penicillins had a significantly lower recurrence rate. Based on these findings, we recommend treatment with penicillinase-stable penicillins and fusidic acid for a total of 8 weeks, with a daily dosage of penicillinase-stable penicillins higher than 4 g.
The diagnosis of vertebral S aureus osteomyelitis based on clinical findings is difficult to ascertain. Bone scans are necessary because radiographic methods do not detect disease as early. Treatment with penicillinase-stable penicillins, at least 4 g/d for at least 8 weeks, is recommended.
血源性金黄色葡萄球菌性脊柱骨髓炎的发病率正在迅速上升，而关于这种严重疾病的诊断、治疗和预后的研究很少。
基于全国范围的登记，回顾了1980年至1990年丹麦133例血培养金黄色葡萄球菌阳性且有脊柱骨髓炎症状患者的临床和细菌学数据。
所回顾的133例脊柱金黄色葡萄球菌骨髓炎病例主要为社区获得性感染（82%），患者多为老年人（中位年龄65岁），且常伴有基础疾病。症状和实验室检查结果都相对缺乏特异性。与传统X线摄影相比，骨扫描方法在早期诊断脊柱金黄色葡萄球菌骨髓炎方面被证明更具优势，传统X线摄影在疾病形成阶段缺乏一致性。感染大多（70%）局限于脊柱下部。复发率和治疗失败率分别取决于耐青霉素酶青霉素的使用时间和剂量。除耐青霉素酶青霉素外还接受夫西地酸治疗的患者复发率显著降低。基于这些发现，我们建议使用耐青霉素酶青霉素和夫西地酸联合治疗共8周，耐青霉素酶青霉素的日剂量高于4克。
基于临床表现诊断脊柱金黄色葡萄球菌骨髓炎很难确定。骨扫描是必要的，因为X线摄影方法不能早期检测到疾病。建议使用耐青霉素酶青霉素治疗，至少4克/天，至少8周。
