Vertebral Osteomiyelit: Son 10 Yılda Neler Değişti?

Öz

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.

Anahtar Kelimeler

• Spondilodiskit
• Vertebral Osteomiyelit
• Piyojenik
• Bruselloz
• Tüberküloz

Vertebral Osteomyelitis: What has Changed in Last 10 Years?

Öz

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.

Anahtar Kelimeler

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

Kaynakça

1. Nickerson EK, Sinha R. Vertebral osteomyelitis in adults: An update. Br Med Bull. 2016;117(1):121–38.
2. Akiyama T, Chikuda H, Yasunaga H, Horiguchi H, Fushimi K, Saita K. Incidence and risk factors for mortality of vertebral osteomyelitis: a retrospective analysis using the Japanese diagnosis procedure combination database. BMJ Open. 2013;3(3):e002412.
3. Mustapić M, Višković K, Borić I, Marjan D, Zadravec D, Begovac J. Vertebral osteomyelitis in adult patients--characteristics and outcome. Acta clinica Croatia. 2016;55(1):9–15.
4. Corrah TW, Enoch DA, Aliyu SH, Lever AM. Bacteraemia and subsequent vertebral osteomyelitis: a retrospective review of 125 patients. QJM. 2011;104(3):201–7.
5. Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 2009;39(1):10–7.
6. An HS, Seldomridge JA. Spinal infections: diagnostic tests and imaging studies. Clin Orthop Relat Res. 2006;444:27–33.
7. Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, et al. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clinical Infectious Diseases. 2015;61(6):e26-46.
8. Bassetti M, Carnelutti A, Muser D, Righi E, Petrosillo N, Gregorio F Di, et al. 18F-Fluorodeoxyglucose positron emission tomography and infectious diseases: current applications and future perspectives. Curr Opin Infect Dis. 2017;30(2):192–200.

9. Mete B, Kurt C, Yilmaz MH, Ertan G, Ozaras R, Mert A, et al. Vertebral osteomyelitis: eight years’ experience of 100 cases. Rheumatol Int. 2012;32(11):3591–7.
10. Therese KL, Jayanthi U, Madhavan HN. Application of nested polymerase chain reaction (nPCR) using MPB 64 gene primers to detect Mycobacterium tuberculosis DNA in clinical specimens from extrapulmonary tuberculosis patients. Indian J Med Res. 2005;122(2):165–70.
11. McDonald M (2020) Vertebral osteomyelitis and discitis in adults. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA.
12. Kehrer M, Pedersen C, Jensen TG, Lassen AT. Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. J Infect. 2014;68(4):313–20.
13. Loibl M, Stoyanov L, Doenitz C, Brawanski A, Wiggermann P, Krutsch W, et al. Outcome-related co-factors in 105 cases of vertebral osteomyelitis in a tertiary care hospital. Infection. 2014;42(3):503–10.
14. Chelsom J, Solberg CO. Vertebral osteomyelitis at a Norwegian university hospital 1987-97: clinical features, laboratory findings and outcome. Scand J Infect Dis. 1998;30(2):147–51.
15. Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother. 2010;65 Suppl 3:iii11-24.
16. Beronius M, Bergman B, Andersson R. Vertebral osteomyelitis in Göteborg, Sweden: a retrospective study of patients during 1990-95. Scand J Infect Dis. 2001;33(7):527–32.
17. Perronne C, Saba J, Behloul Z, Salmon-Céron D, Leport C, Vildé JL, et al. Pyogenic and tuberculous spondylodiskitis (vertebral osteomyelitis) in 80 adult patients. Clinical Infectious Diseases. 1994;19(4):746–50.
18. Weisz RD, Errico TJ. Spinal infections. Diagnosis and treatment. Bull Hosp Jt Dis. 2000;59(1):40–6.
19. Colmenero JD, Jiménez-Mejías ME, Sánchez-Lora FJ, Reguera JM, Palomino-Nicás J, Martos F, et al. Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Annals of rheumatic diseases. 1997;56(12):709–15.
20. Gök SE, Kaptanoğlu E, Celikbaş A, Ergönül O, Baykam N, Eroğlu M, et al. Vertebral osteomyelitis: clinical features and diagnosis. Clinical microbiology and infection. 2014;20(10):1055–60.
21. Lemaignen A, Ghout I, Dinh A, Gras G, Fantin B, Zarrouk V, et al. Characteristics of and risk factors for severe neurological deficit in patients with pyogenic vertebral osteomyelitis: A case-control study. Medicine (Baltimore). 2017;96(21):e6387.
22. Saeed K, Esposito S, Ascione T, Bassetti M, Bonnet E, Carnelutti A, et al. Hot topics on vertebral osteomyelitis from the International Society of Antimicrobial Chemotherapy. Int J Antimicrob Agents. 2019;54(2):125–33.
23. Altini C, Lavelli V, Niccoli-Asabella A, Sardaro A, Branca A, Santo G, et al. Comparison of the Diagnostic Value of MRI and Whole Body 18 F-FDG PET/CT in Diagnosis of Spondylodiscitis. J Clin Med. 2020;9(5):1581.
24. Kwon JW, Hyun SJ, Han SH, Kim KJ, Jahng TA. Pyogenic Vertebral Osteomyelitis: Clinical Features, Diagnosis, and Treatment. Korean J Spine. 2017;14(2):27–34.
25. Skanjeti A, Penna D, Douroukas A, Cistaro A, Arena V, Leo G, et al. PET in the clinical work-up of patients with spondylodiscitis: a new tool for the clinician? The quarterly journal of nuclear medicine and molecular imaging. 2012;56(6):569–76.
26. Fantoni M, Trecarichi EM, Rossi B, Mazzotta V, Giacomo G Di, Nasto LA, et al. Epidemiological and clinical features of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012;16 Suppl 2:2–7.
27. Grados F, Lescure FX, Senneville E, Flipo RM, Schmit JL, Fardellone P. Suggestions for managing pyogenic (non-tuberculous) discitis in adults. Joint Bone Spine. 2007;74(2):133–9.
28. Flury BB, Elzi L, Kolbe M, Frei R, Weisser M, Schären S, et al. Is switching to an oral antibiotic regimen safe after 2 weeks of intravenous treatment for primary bacterial vertebral osteomyelitis? BMC Infect Dis. 2014;14:226.
29. Unuvar GK, Kilic AU, Doganay M. Current therapeutic strategy in osteoarticular brucellosis. North Clin Istanb. 2019;6(4):415–20.
30. Republic of Turkey Ministery of Health, Turkish Public Health Institution, Department of Zoonotic and Vector Borne Diseases. Brucellosis Statistical Data. https://hsgm.saglik.gov.tr/tr/zoonotikvektorel-bruselloz/istatistik (Accessed on March 26, 2021).
31. Horasan ES, Colak M, Ersöz G, Uğuz M, Kaya A. Clinical findings of vertebral osteomyelitis: Brucella spp. versus other etiologic agents. Rheumatol Int. 2012;32(11):3449–53.
32. Jain AK, Rajasekaran S. Tuberculosis of the spine. Indian J Orthop. 2012;46(2):127–9.
33. Colmenero JD, Ruiz-Mesa JD, Sanjuan-Jimenez R, Sobrino B, Morata P. Establishing the diagnosis of tuberculous vertebral osteomyelitis. European Spine Journal. 2013;22 Suppl 4(Suppl 4):579–86.
34. Kouijzer IJE, Scheper H, Rooy JWJ de, Bloem JL, Janssen MJR, Hoven L van den, et al. The diagnostic value of 18 F-FDG-PET/CT and MRI in suspected vertebral osteomyelitis - a prospective study. Eur J Nucl Med Mol Imaging. 2018;45(5):798–805.