原发性脊柱感染患者X线透视引导下穿刺活检细菌培养阳性率及影响因素

Positive rate of bacterial culture of X-ray fluoroscopy-guided percutaneous biopsy in primary spinal infections and influencing factors

中文关键词:  脊柱感染  穿刺活检  阳性率  影响因素

英文关键词:Spinal infections  Percutaneous biopsy  Positive rate  Influencing factors

中文摘要:

  【摘要】 目的：统计X线透视引导下穿刺活检在原发性脊柱感染患者中的细菌培养阳性率，分析影响穿刺培养阳性的因素。方法：回顾性分析2018年8月~2021年8月因原发性脊柱感染在南方医院脊柱骨科和南方医院增城分院骨科行透视引导下经皮穿刺活检的病例，共纳入179例患者，男性110例，女性69例，平均年龄54.63±13.70岁。按穿刺培养结果分为培养阳性组（n=100）和培养阴性组（n=79）。计算培养阳性率，探讨人口统计资料、抗生素干预、临床特征、实验室检查、影像学数据、穿刺操作、血培养及组织病理学结果对培养阳性的影响，采用Logistic回归分析确定培养阳性相关的影响因素。结果：穿刺活检培养阳性率为56%，100例穿刺培养阳性标本共培养出36种119株微生物，其中培养出单一微生物81例（81%）；主要微生物包括：结核分枝杆菌（n=24）、表皮葡萄球菌（n=16）、金黄色葡萄球菌（n=12）、大肠埃希菌（n=8）、布鲁氏菌（n=8）。Logistic回归分析显示C反应蛋白（C-reactive protein）、穿刺部位、穿刺节段对穿刺培养阳性结果无影响，高血压（OR 0.139；95%CI：0.038~0.500；P=0.003）、抗生素干预（OR 0.221；95%CI：0.063~0.784；P=0.019）及椎旁脓肿（OR 8.495；95%CI：1.623~44.479；P=0.011）是穿刺培养阳性的影响因素。结论：原发性脊柱感染透视引导下穿刺活检培养阳性率为56%，高血压、椎旁脓肿及抗生素干预是影响穿刺培养阳性结果的危险因素。

英文摘要:

  【Abstract】 Objectives: To calculate the positive bacterial culture rate of X-ray fluoroscopy-guided percutaneous biopsy in primary spinal infections and analyze the factors influencing the positive cultures. Methods: A total of 179 patients with primary spinal infections who underwent fluoroscopy-guided percutaneous biopsy in the Division of Spine Surgery of Nanfang Hospital and Orthopedics Department of Nanfang Hospital Zengcheng Branch from August 2018 to August 2021 were retrospectively reviewed, including 110 males and 69 females, aged 54.63±13.70 years old. Cases were divided into culture-positive group(n=100) and culture-negative group(n=79) based on culture results. The culture positive rate was calculated, and the factors including demographics, antibiotics intervention, clinical manifestation, laboratory examination, imaging data, biopsy procedure, blood culture, and histopathology examination were analyzed to determine the culture positive-related influencing facors by Logistic regression analysis. Results: The culture positive rate of biopsy was 56%. A total of 119 strains of 36 species of microorganisms were cultured from 100 puncture culture positive specimens, among which 81 strains(81%) were single microorganisms. The common microorganisms were Mycobacterium tuberculosis(n=24), Staphylococcus epidermis(n=16), Staphylococcus aureus(n=12), Escherichia coli(n=8), and Brucella(n=8). Logistic regression analysis showed that the level of CRP, biopsy site, biopsy level had no effect on the positive results of biopsy culture, while hypertension(OR 0.139, 95%CI: 0.038-0.500, P=0.003), antibiotics intervention(OR 0.221, 95%CI: 0.063-0.784, P=0.019), and paravertebral abscess(OR 8.495, 95%CI:1.623-44.479, P=0.011) were the influencing factors for positive biopsy cultures. Conclusions: The overall positive bacterial culture rate of fluoroscopy-guided percutaneous puncture biopsy in primary spinal infections is 56%, and hypertension, antibiotics intervention, and paravertebral abscess are the factors influencing the biopsy culture results.