中间普雷沃菌引起脊柱感染误诊分析及文献综述

Spinal infection caused by Prevotella intermedia:analysis of misdiagnosis and literature review

目的探讨中间普雷沃菌引起脊柱感染患者的临床特点及诊治方案。方法总结某院脊柱外科收治的1例中间普雷沃菌引起脊柱感染患者的临床诊疗过程,并检索数据库相关文献进行复习。结果患者男性,50岁,因“腰痛伴双下肢疼痛2个月”入院,取病变组织进行宏基因组二代测序(mNGS)检测示中间普雷沃菌,诊断为中间普雷沃菌脊柱炎,经开放病灶清除、置管冲洗+自体骨移植融合内固定术治疗后给予头孢曲松钠和甲硝唑静脉滴注,奥硝唑冲洗治疗后感染获得控制。共检索出符合条件文献16篇,加上本病例,共纳入17例患者,其中男性7例,女性10例;危险因素主要为糖尿病和使用皮质类固醇病史(占35.3%);最常见的侵犯部位为腰椎(12例)、胸椎(6例)等;病原学培养阳性13例;分子学检测阳性3例,染色镜检阳性1例。17例患者均接受了抗厌氧菌治疗,其中14例联合手术治疗;1例死亡,病死率为5.9%,5例存在部分神经功能损伤,致残率为29.4%。抗厌氧菌治疗联合手术者生存率为92.8%,3例单独抗厌氧菌治疗未行手术者均治愈。结论中间普雷沃菌是一种机会致病菌,多发生于免疫功能低下者,易误诊,建议尽早送检mNGS明确病原体,以争取救治时机,降低病死率。

Objective To explore the clinical characteristics and treatment scheme of patients with spinal infection caused by Prevotella intermedia(P.intermedia).Methods Clinical diagnosis and treatment processes of a patient with spinal infection caused by P.intermedia admitted to the spinal surgery department of a hospital were summarized,and relevant literature was retrieved from database for reviewing.Results The patient,a 50 year old male,was admitted to the hospital due to“lumbago pain complicated with pain in double lower extremities for 2 months”.The lesion tissue was taken for metagenomic next-generation sequencing(mNGS)detection,which detected P.intermedia,and the patient was diagnosed with P.intermedia spondylitis.After treatments with open lesion clea-rance,tube rinsing+autologous bone transplantation fusion internal fixation,intravenous drip of ceftriaxone sodium and metronidazole,as well as metronidazole rinsing,infection was under control.A total of 16 available papers were retrieved,together with this case,a total of 17 patients were included,with 7 males and 10 females.The main risk factors were diabetes and history of corticosteroid use(35.3%).The most common invasion sites were lumbar vertebra(n=12)and thoracic vertebra(n=6).13 cases were positive for pathogen culture,3 cases were positive for molecular detection,and 1 case was positive for staining microscopy.17 patients received anti-anaerobic bacteria treatment,with 14 cases receiving combined surgical treatment.One case died,with a mortality of 5.9%;5 cases had partial neurological impairment,with a disability rate of 29.4%.The survival rate of patients who received treatment of anti-anaerobic bacteria combined with surgery was 92.8%,3 patients only with anti-anaerobic bacteria treatment but without surgery were all cured.Conclusion P.intermedia is an opportunistic pathogeanic bacteria which often causes infection in immunocomprised individuals and is prone to be misdiagnosed.It is recommended to perform mNGS detection to identify the pathogen as early as possible and seize the opportunity for treatment to reduce mortality.