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De novo methicillin-resistant Staphylococcus aureus vs. methicillin-sensitive Staphylococcus aureus infections of the spine, similar clinical outcome, despite more severe presentation in surgical patients.
Neurosurgical Review ( IF 2.5 ) Pub Date : 2020-08-27 , DOI: 10.1007/s10143-020-01376-2
Basem Ishak 1, 2 , Amir Abdul-Jabbar 1 , Gregory B Moss 3 , Emre Yilmaz 1, 4 , Alexander von Glinski 1, 4 , Sven Frieler 1, 4 , Andreas W Unterberg 2 , Ronan Blecher 1 , Juan Altafulla 1 , Jeffrey Roh 1 , Robert A Hart 1 , Rod J Oskouian 1 , Jens R Chapman 1
Affiliation  

Vertebral osteomyelitis (VO) is a severe infection of the vertebral body and the adjacent disc space, where Staphylococcus aureus is most commonly isolated. The objective of this retrospective study was to determine risk factors for and compare outcome differences between de novo methicillin-resistant Staphylococcus aureus (MRSA) VO and methicillin-sensitive Staphylococcus aureus (MSSA) VO. A retrospective cohort study was performed by review of the electronic medical records of 4541 consecutive spine surgery patients. Among these 37 underwent surgical treatment of de novo MRSA and MSSA spinal infections. Patient demographics, pre- and postoperative neurological status (ASIA impairment score), surgical treatment, inflammatory laboratory values, nutritional status, comorbidities, antibiotics, hospital stay, ICU stay, reoperation, readmission, and complications were collected. A minimum follow-up (FU) of 12 months was required. Among the 37 patients with de novo VO, 19 were MRSA and 18 were MSSA. Mean age was 52.4 and 52.9 years in the MRSA and MSSA groups, respectively. Neurological deficits were found in 53% of patients with MRSA infection and in 17% of the patients with MSSA infection, which was statistically significant (p < 0.05). Chronic renal insufficiency and malnutrition were found to be significant risk factors for MRSA VO. Preoperative albumin was significantly lower in the MRSA group (p < 0.05). Patients suffering from spinal infection with chronic renal insufficiency and malnutrition should be watched more carefully for MRSA. The MRSA group did not show a significant difference with regard to final clinical outcome despite more severe presentation.



中文翻译:

新发耐甲氧西林金黄色葡萄球菌与耐甲氧西林金黄色葡萄球菌的脊柱感染相比,尽管在手术患者中表现更严重,但临床结果相似。

椎体骨髓炎 (VO) 是椎体和相邻椎间盘间隙的严重感染,其中金黄色葡萄球菌最常分离。这项回顾性研究的目的是确定新发耐甲氧西林金黄色葡萄球菌(MRSA) VO 和甲氧西林敏感金黄色葡萄球菌的危险因素并比较结果差异。(MSSA) VO。通过回顾 4541 名连续脊柱手术患者的电子病历进行了一项回顾性队列研究。其中 37 人接受了新发 MRSA 和 MSSA 脊柱感染的手术治疗。收集了患者人口统计学、术前和术后神经学状态(ASIA 损伤评分)、手术治疗、炎症实验室值、营养状况、合并症、抗生素、住院时间、ICU 住院时间、再手术、再入院和并发症。需要至少 12 个月的随访 (FU)。在 37 例新发 VO 患者中,19 例为 MRSA,18 例为 MSSA。MRSA 和 MSSA 组的平均年龄分别为 52.4 和 52.9 岁。在 53% 的 MRSA 感染患者和 17% 的 MSSA 感染患者中发现神经功能缺损,p  < 0.05)。发现慢性肾功能不全和营养不良是 MRSA VO 的重要危险因素。MRSA 组的术前白蛋白显着降低(p  < 0.05)。患有慢性肾功能不全和营养不良的脊柱感染患者应更仔细地观察 MRSA。尽管表现更严重,但 MRSA 组在最终临床结果方面没有显示出显着差异。

更新日期:2020-08-27
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