Vertebral osteomyelitis: Long-term outcome for 253 patients from 7 Cleveland-area hospitals
Vertebral osteomyelitis: Long-term outcome for 253 patients from 7 Cleveland-area hospitals
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DOI：
10.1086/340102
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发表时间：
2002-05-15
影响因子：
11.8
通讯作者：
Locker, GA
中科院分区：
文献类型：
--
作者：
McHenry, MC;Easley, KA;Locker, GA
我们报告了一项对253例脊椎骨髓炎（VO）患者进行长期随访的回顾性研究。11%的患者死亡，超过三分之一的幸存者发生残留残疾，14%的患者复发。中位随访时间为6.5年（范围：2天至38年）。不良结局（死亡或合格恢复）的独立风险因素为神经功能损害、诊断时间和医院感染（P <0.004）。手术治疗导致109例患者中86例（79%）恢复或改善。磁共振成像（110例患者）通常是在感染过程的后期获得的，对结果没有显著影响。通常情况下，复发发生在有严重椎体破坏和脓肿的个体中，出现在手术引流或清创后一段时间。复发性菌血症、椎旁脓肿和慢性鼻窦引流与复发独立相关（P <0.001）。VO的最佳结局需要提高认识，早期诊断，及时识别病原体，逆转并发症和延长抗菌治疗。
We report a retrospective study of 253 patients with vertebral osteomyelitis (VO) who had long-term follow-up. Eleven percent of the patients died, residual disability occurred in more than one-third of the survivors, and relapse occurred in 14%. Median duration of follow-up was 6.5 years (range, 2 days to 38 years). Independent risk factors for adverse outcome (death or qualified recovery) were neurologic compromise, time to diagnosis, and hospital acquisition of infection (P less than or equal to.004). Surgical treatment resulted in recovery or improvement in 86 (79%) of 109 patients. Magnetic resonance images (110 patients) were often obtained late in the course of infection and did not significantly affect outcome. Often, relapse developed in individuals with severe vertebral destruction and abscesses, appearing some time after surgical drainage or debridement. Recurrent bacteremia, paravertebral abscesses, and chronically draining sinuses were independently associated with relapse (Pless than or equal to.001). An optimal outcome of VO requires heightened awareness, early diagnosis, prompt identification of pathogens, reversal of complications, and prolonged antimicrobial therapy.