急性化脓性骨髓炎患者病原菌分布及早期MRI诊断价值分析  

Distribution of pathogenic bacteria in patients with acute suppurative Osteomyelitis and the value of early MRI diagnosis

作　　者：刘成升 董洲 韩国嵩 马力 李海龙 LIU Chengsheng;DONG Zhou;HAN Guosong;MA Li;LI Hailong(Deparment of Spine and Orthopedic,the Third Affiliated Hospital of Anhui Medical University,Hefei 2300ol,China;Second People's Hospital of Fuyang,Orthopaedics)

机构地区：[1]安徽医科大学第三附属医院脊柱骨科,安徽合肥230000 [2]阜阳市第二人民医院

出　　处：《中国病原生物学杂志》2023年第11期1341-1345,共5页Journal of Pathogen Biology

基　　金：安徽省高校科研项目基金(No.2022AH050768)。

摘　　要：目的分析急性化脓性骨髓炎患者病原菌分布特点及早期MRI诊断价值。方法回顾性分析本院脊柱骨科接诊的92例急性化脓性骨髓炎患者及60例同期体检健康者的临床资料。采集患者窦道分泌物进行细菌培养及病原菌鉴定。培养分离的金黄色葡萄球菌检测后分为MRSA与MSSA两组,对比两组菌株的耐药性。采集急性化脓性骨髓炎患者及健康对照组的静脉血,检测血清CRP、ESR水平。对急性化脓性骨髓炎患者早期进行X线、CT、MRI检查,对比三种检查方式的诊断准确率、软组织病变率、骨髓异常率,分析MRI在急性化脓性骨髓炎早期的诊断价值。结果92例急性化脓性骨髓炎患者共培养出104株病原菌,81例患者为单一病原菌感染。65株为革兰阳性菌,以金黄色葡萄球菌为主。39株为革兰阴性菌,以铜绿假单胞菌为主。43株金黄色葡萄球菌中共检出14株MRSA,检出率为32.56%。MRSA对青霉素、红霉素、阿奇霉素、克林霉素的耐药率均高于MSSA,其中对阿奇霉素的耐药率差异有统计学意义(P<0.05)。两组菌株对环丙沙星、左氧氟沙星、莫西沙星、庆大霉素、四环素、复方新诺明的耐药率均低于40%,其中对环丙沙星、莫西沙星的耐药率差异有统计学意义(P<0.05),未发现对万古霉素、利奈唑胺的耐药株。急性化脓性骨髓炎患者血清CRP、ESR水平均显著高于健康对照组(t=28.107,40.574;P<0.05)。X线共检出47例,45例患者于患病12 d内可观察到局部软组织肿胀,17例患者于发病两周后可观察到局限性骨质疏松,诊断准确率为51.09%(47/92),软组织病变检出率为48.91%(45/92),骨髓异常检出率为18.48%(17/92)。CT共检出58例,55例患者于患病7 d内可观察到局部软组织肿胀,29例患者于发病7~10 d内可观察到局限性骨质疏松、异常,患病10 d后可见明显骨皮质损失及骨膜反应表现,诊断准确率为63.04%(58/92),软组织病变检出率为59.78%(55/92),�Objective To analyze the distribution of pathogenic bacteria in patients with acute suppurative Osteomyelitis and the value of early MRI diagnosis.Methods The clinical data of 92 cases of acute suppurative osteomyelitis and 60 cases of healthy people in the same period who were admitted to the Department of Spine and Orthopaedics in our hospital were analyzed retrospectively.The patient sinus secretions were collected for bacterial culture and pathogen identification.The Staphylococcus aureus isolated in this study were divided into MRSA and MSSA groups after detection,and the drug resistance of the two groups was compared.The venous blood of patients with acute suppurative Osteomyelitis and healthy control group was collected to detect the serum CRP and ESR levels.X-ray,CT and MRI were performed in the early stage of acute suppurative Osteomyelitis.The diagnostic accuracy,soft tissue lesion rate and bone marrow abnormality rateof the three examination methodswere compared,and the diagnostic value of MRI in the early stage of acute suppurative Osteomyelitis was analyzed.Results A total of 104 strains of pathogenic bacteria were cultured from 92 patients with acute suppurative Osteomyelitis,and 8l patients were infected by a single pathogen.65 strains were Gram positive bacteria,mainly Staphylococcus aureus.39 strains were Gram negative bacteria,mainly Pseudomonas aeruginosa.A total of 14 MRSA strains were detected from 43 S.aureus strains,with a detection rate of 32.56%.The drug resistance rate of MRSA to penicillin,Erythromycin,Azithromycin and Clindamycin was higher than that of MSSA,and the drug resistance rate to Azithromycin was significantly different between the two groups(P<0.05).The drug resistance rates of the two groups of strains to Ciprofloxacin,Levofloxacin,Moxifloxacin,Gentamicin,tetracycline,and Trimethoprim/sulfamethoxazole were all lower than 40%,of which the drug resistance rates to Ciprofloxacin and Moxifloxacin were statistically different(P<0.05),there were no strains resistant to Vancomycin

关 键 词：急性化脓性骨髓炎 病原菌 耐甲氧西林金黄色葡萄球菌 磁共振成像 

分 类 号：R378[医药卫生—病原生物学]