全内镜脊柱手术使化脓性脊柱炎患者在短期抗生素治疗后获得高病原体鉴定率

文献信息

中文摘要

引言： 及时、准确地鉴定病原体对于化脓性脊柱炎的有效治疗至关重要。然而，传统非手术方法，如血培养和经皮穿刺活检，其敏感性和可靠性有限。这项多中心研究探讨了在全内镜脊柱手术（FESS）中采集标本是否比传统诊断方法更有用。
方法： 我们回顾性分析了2021年1月至2025年4月期间在三家参与机构诊断为化脓性脊柱炎的53例患者的数据。比较FESS、经皮穿刺活检和血培养之间的病原体鉴定率。根据操作前抗生素治疗持续时间（0天、1-13天或≥14天）将患者分为三组，以确定抗生素暴露对诊断率的影响。进行多变量分析以校正炎症标志物和临床因素。
结果： 总体病原体鉴定率为79.2%，其中大肠埃希菌（20.8%）和金黄色葡萄球菌（17.0%）是最常见的分离菌。FESS的鉴定率最高（59.2%），其次是穿刺活检（45.2%）和血培养（38.6%）。尽管在未使用抗生素的患者中三种方法的检出率相似，但在抗生素使用1-13天组中，FESS的检出率显著高于血培养（87.5% vs 16.7%，p=0.026），而FESS与穿刺活检（57.1%）之间的差异无统计学意义。FESS在15.6%的患者中获得阳性结果，即在血培养和穿刺活检均为阴性的情况下仍鉴定出病原体。
结论： FESS能够对感染组织进行直接靶向采样，因此其病原体鉴定率高于传统诊断方法，尤其是在短期抗生素暴露的患者中。与穿刺活检不同，FESS允许在直视下获取足够的样本。这些发现表明，FESS是一种有价值的诊断工具，可补充其治疗作用，并可能有助于更早优化抗菌治疗。

英文摘要

INTRODUCTION: Prompt and accurate identification of pathogens is essential for effective treatment of pyogenic spondylitis. However, conventional non-surgical methods, such as blood culture and percutaneous needle biopsy, have limited sensitivity and reliability. This multicenter study investigated whether specimen collection during full-endoscopic spine surgery (FESS) is more useful than the conventional diagnostic modalities.
METHODS: We retrospectively analyzed data for 53 patients diagnosed with pyogenic spondylitis across three participating institutions between January 2021 and April 2025. Pathogen identification rates were compared between FESS, percutaneous needle biopsy, and blood culture. The patients were stratified into three groups based on duration of pre-procedural antibiotic therapy (0 days, 1-13 days, or ≥14 days) to determine the influence of antibiotic exposure on diagnostic yield. Multivariate analysis was performed to adjust for inflammatory markers and clinical factors.
RESULTS: The overall pathogen identification rate was 79.2%, with Escherichia coli (20.8%) and Staphylococcus aureus (17.0%) being the most frequent isolates. FESS achieved the highest identification rate (59.2%), followed by needle biopsy (45.2%) and blood culture (38.6%). Although detection rates were similar among the three methods in antibiotic-naïve patients, FESS demonstrated a significantly higher detection rate in the 1-13-day antibiotic group than blood culture (87.5% vs 16.7%, p=0.026), whereas the difference between FESS and needle biopsy (57.1%) was not statistically significant. FESS yielded positive results in 15.6% of patients, identifying pathogens despite negative findings on both blood culture and needle biopsy.
CONCLUSIONS: FESS enables direct targeted sampling of infected tissues, resulting in pathogen identification rates that are higher than those with conventional diagnostic methods, particularly in patients with short-term antibiotic exposure. Unlike needle biopsy, FESS allows for the retrieval of adequate samples under direct vision. These findings indicate that FESS is a valuable diagnostic tool that complements its therapeutic role, potentially facilitating earlier optimization of antimicrobial therapy.