Гематогенный остеомиелит позвоночника: клиническая и микробиологическая характеристика

Objective . To analyze clinical picture and composition of pathogens of hematogenous pyogenic vertebral osteomyelitis (PVO) based on the records of a regional clinic admitting patients with this disease. Material and Methods . A retrospective monocenter analysis of medical records of patients who underwent treatment for hematogenous PVO at the Tyumen Regional Clinical Hospital No. 2 in 2006–2017 was carried out. The nature of the isolated microflora was studied based on 209 inpatient medical records. Out of them, 68 patients were conservatively treated, and 141 were operated on. Ninety three bacterial strains were isolated from the surgical material in 77 patients, 20 strains – from aspiration biopsy in 32 patients, 21 strains – from blood in 20 patients. Results . The causative agent of PVO was identified in 117 (56.0 %) patients including gram-positive flora in 56.3 % of cases. The main pathogens were Staphylococcus spp. (53.8 %). Oxacillin-sensitive S. aureus (MSSA) was isolated in 35.5 % of cases, its resistant form (MRSA) in 3.3 %. In 26 (12.4 %) patients, two or more pathogens were detected with a predominance of staphylococcal flora. Conclusion . The most common cause of hematogenous PVO is gram-positive flora with a predominance of S. aureus (38.8 %). Anaerobes were identified in 30.6 % of cases. In 26 (12.4 %) cases, more than one pathogen was isolated. There were no significant differences in the form of the disease with gram-positive and gram-negative flora, and polymicrobial lesions (p = 0.498). S. aureus is more common in lesions of the cervical spine in comparison with the thoracic (p = 0.003) and lumbar (p = 0.001) spine. There is a tendency to an increase in peptostreptococci in lesions of the lumbar spine (p = 0.09). S. aureus is significantly more often isolated in acute in acute form of the disease than in subacute (p = 0.009) and chronic (p = 0.012) forms, and peptostreptococci – in subacute (p = 0.001) and chronic (p = 0.003) forms of the disease.