背景:脊椎盘炎(SD)和孤立性脊髓硬膜外脓胸(ISEE)的成功治疗取决于病原体的早期检测,通常通过血液培养进行,术中标本,和/或图像引导活检。我们评估了这三种方法的诊断敏感性,并评估了抗生素对其的影响。
方法:我们回顾性分析了2002年至2021年在德国神经外科大学中心接受手术治疗的SD和ISEE患者的数据。
结果:我们纳入了208例患者(68[23-90]年,34.6%女性,68%SD)。病原菌192例(92.3%),包括187例(97.4%)化脓性感染和5例(2.6%)非化脓性感染,化脓性感染的革兰阳性菌占86.6%(162例),革兰阴性菌占13.4%(25例)。术中标本的诊断灵敏度最高,为77.9%(162/208,p=0.012),血液培养的诊断灵敏度最低,为57.2%(119/208),计算机断层扫描(CT)引导活检的诊断灵敏度最低,为55.7%(39/70)。血培养在SD患者中表现出最高的敏感性(SD:91/142,64.1%vs.ISEE:28/66,42.4%,p=0.004),而术中标本是ISEE中最敏感的手术(SD:102/142,71.8%vs.ISEE:59/66,89.4%,p=0.007)。持续经验性抗生素治疗(EAT)的SD患者的诊断敏感性低于术后靶向抗生素治疗(TAT)的患者(EAT:77/89,86.5%vs.TAT:53/53,100%,p=0.004),而ISEE患者没有观察到效果(EAT:47/51,92.2%vs.TAT:15/15,100%,p=0.567)。
结论:在我们的队列中,术中标本显示出最高的诊断灵敏度,尤其是ISEE,而血培养似乎对SD最敏感。这些测试的敏感性似乎可以通过SD患者的术前EAT来改变,但不是那些有ISEE的人,强调两种病理之间的明显差异。
BACKGROUND: the successful treatment of spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE) depends on early detection of causative pathogens, which is commonly performed either via blood cultures, intraoperative specimens, and/or image-guided biopsies. We evaluated the diagnostic sensitivity of these three procedures and assessed how it is influenced by antibiotics.
METHODS: we retrospectively analyzed data from patients with SD and ISEE treated surgically at a neurosurgery university center in Germany between 2002 and 2021.
RESULTS: we included 208 patients (68 [23-90] years, 34.6% females, 68% SD). Pathogens were identified in 192 cases (92.3%), including 187 (97.4%) pyogenic and five (2.6%) non-pyogenic infections, with Gram-positive bacteria accounting for 86.6% (162 cases) and Gram-negative for 13.4% (25 cases) of the pyogenic infections. The diagnostic sensitivity was highest for intraoperative specimens at 77.9% (162/208, p = 0.012) and lowest for blood cultures at 57.2% (119/208) and computed tomography (CT)-guided biopsies at 55.7% (39/70). Blood cultures displayed the highest sensitivity in SD patients (SD: 91/142, 64.1% vs. ISEE: 28/66, 42.4%, p = 0.004), while intraoperative specimens were the most sensitive procedure in ISEE (SD: 102/142, 71.8% vs. ISEE: 59/66, 89.4%, p = 0.007). The diagnostic sensitivity was lower in SD patients with ongoing empiric antibiotic therapy (EAT) than in patients treated postoperatively with targeted antibiotic therapy (TAT) (EAT: 77/89, 86.5% vs. TAT: 53/53, 100%, p = 0.004), whereas no effect was observed in patients with ISEE (EAT: 47/51, 92.2% vs. TAT: 15/15, 100%, p = 0.567).
CONCLUSIONS: in our cohort, intraoperative specimens displayed the highest diagnostic sensitivity especially for ISEE, whereas blood cultures appear to be the most sensitive for SD. The sensitivity of these tests seems modifiable by preoperative EAT in patients with SD, but not in those with ISEE, underscoring the distinct differences between both pathologies.