Vertebral Osteomiyelit: Son 10 Yılda Neler Değişti?

Abstract

Amaç: Bu çalışmada, vertebral osteomiyelit vakalarının son 10 yıldaki demografik, klinik ve mikrobiyolojik özelliklerindeki değişimlerin saptanması, bu bulguların mevcut literatür ve hastanemizde yapılan bir önceki vaka serisi ile karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: 2009-2019 yılları arasında İstanbul Üniversitesi-Cerrahpaşa Cerrahpaşa Tıp Fakültesi’nde vertebral osteomiyelit tanısı ile takip edilen hastaların verileri retrospektif olarak tarandı. Tüm hastalar piyojenik, tüberküloz ve brusellar vertebral osteomiyelit olmak üzere üç ana gruba ayrıldı. Bulgular: Çalışmaya toplam 100 vaka dahil edildi. Bu 100 hastanın 59’unda piyojenik, 15’inde brusella ve 26’sında tüberküloz vertebral osteomiyeliti saptandı. Piyojenik vertebral osteomyelit vakalarının 22’si (%37.4) postoperatif olarak gelişti. En sık izole edilen mikroorganizma Staphylococcus aureus (n = 11), ardından koagülaz negatif stafilokoklar (n = 6) idi. Brusella vertebral osteomiyeliti oranı önceki vaka serilerinden daha düşüktü (15’e karşı 24). Uygun antimikrobiyal tedavinin ardından laboratuvar bulgularında düzelmeye kadar geçen medyan süre 14 gündü. PET-CT, MR’a benzer şekilde piyojenik vertebral osteomiyelit hastalarının %81.8’inde tanı koydurucuydu. Ancak tüberküloz vertebral osteomiyeliti hastalarında PET-CT tanı oranı anlamlı olarak düşük saptandı (9’da 3, p=0,040). Sonuç: S. aureus en sık izole edilen mikroorganizma olmaya devam etti. Koagülaz negatif stafilokok enfeksiyon oranı artmış olup, temelde postoperatif enfeksiyon ile ilişkilendirilmiştir. Brusella vertebral osteomiyeliti oranı daha düşük olarak saptanmıştır. Bu durumun etkili hayvan aşılama programları ve pastörizasyon ile ilişkili olduğu düşünülmüştür. MR tanıda altın standart olmasına rağmen, PET-CT özellikle piyojenik vertebral osteomiyelit tanısında umut vericidir.

Keywords

• Spondilodiskit
• Vertebral Osteomiyelit
• Piyojenik
• Bruselloz
• Tüberküloz

Vertebral Osteomyelitis: What has Changed in Last 10 Years?

Abstract

Objective: This study was conducted to describe the demographic, clinical, and microbiological characteristics of vertebral osteomyelitis in the last decade, mainly by comparing literature and the previous case series performed in our center. Material and Methods: This is a retrospective, observational, descriptive study performed between 2009-2019 at Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine. All patients were divided into three main groups: pyogenic, tuberculous and brucellar. Results: A total of 100 cases were included in this study. Of these 100 patients, 59 had pyogenic, 15 had brucellar and 26 had tuberculous spondylodiscitis. The disease developed postoperatively in 22 (37.4%) of the 59 pyogenic vertebral osteomyelitis cases. The common isolated microorganism was Staphylococcus aureus (n = 11), followed by coagulase negative staphylococci (n = 6). Brucellar vertebral osteomyelitis rate was lower than previous case series (15 vs. 24). The median time to improvement in the laboratory findings after the administration of the appropriate treatment was 14 days. PET-CT was diagnostic in 81.8% of pyogenic vertebral osteomyelitis patients, similar to MRI. However, PET-CT diagnosis rate was significantly low in tuberculous spondylodiscitis (3 out of 9, p = 0.040). Conclusion: S. aureus remained the most common etiologic agent. Coagulase negative staphylococci infection rate, mainly related to spinal surgery, and postoperative spondylodiscitis rate is higher than before. Brucellar vertebral osteomyelitis rate is lower, which is mostly related to effective animal vaccination and pasteurization. Although, MRI is the gold standard, PET-CT is a promising technique in diagnosis for pyogenic vertebral osteomyelitis.

Keywords

• Spondylodiscitis;
• Vertebral osteomyelitis
• Pyogenic
• Brucellar
• Tuberculous

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