2000-2020 yılları arasında Bursa Uludağ Üniversitesi Tıp Fakültesi Hastanesi Enfeksiyon Hastalıkları Kliniği ve polikliniğinde takip edilen enfektif spondilodiskit tanılı hastaların retrospektif incelenmesi
Date
2022
Authors
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Spondilodiskitin klinik bulguları özgül olmadığı için tanıda zorluklar ve gecikmeler yaşanabilir. Tedavi başarısı için etkene yönelik tedavi verilmesi esastır. Çalışmamızda spondilodiskit hastalarının klinik yansımaları, tanı yöntemleri, tedavi seçenekleri incelenerek hastaların morbiditesinin azalması için erken tanı alabilmesi ve etkin tedavi seçeneklerinin belirlenmesi amaçlandı. Çalışmamızda 1 Ocak 2000 ile 31 Aralık 2020 tarihleri arasında Bursa Uludağ Üniversitesi Tıp Fakültesi Hastanesi Enfeksiyon Hastalıkları Kliniği ve Polikliniği'nde takip edilen 18 yaş ve üstündeki enfeksiyöz spondilodiskit tanılı hastalar retrospektif değerlendirildi. Çalışmamıza 336 hasta dahil edildi. Hastaların 55 (%16,4)'i tüberküloz spondilodiskit, 86 (%25,6)'sı brusellar spondilodiskit, 195 (%58)'i piyojenik spondilodiskit tanılıydı. Piyojenik spondilodiskit hastalarının 107 (n=195, %54,9)'si toplum kökenli, 88 (n=195, %45,1)'i postoperatif gelişen spondilodiskitti. Tüm gruplar arasında en sık şikayet bel ağrısıydı (%77). En sık etkilenen vertebra tüberküloz spondilodiskitinde torakal vertebra (%45,5), brusellar spondilodiskitte lomber vertebra (%51,1), piyojenik spondilodiskitte lomber vertebra (%53,8) idi. Tüberküloz spondilodiskiti tanısı için 55 hastanın 53 (%96,3)'üne girişimsel işlem yapıldığı, hastaların 32 (%58)'sinde histopatolojinin tanıyı desteklediği ve 19 (%34,5)'unda kültürde üreme olduğu saptandı. Brusellar spondilodiskit tanısında brusella aglütinasyon testi ile 82 (%93), kültürde üreme ile 12 (%13,9) hastaya tanı konulduğu görüldü. Piyojenik spondilodiskit tanısında 195 hastanın 94 (%48,2)'üne girişimsel işlem yapıldığı, histopatoloji ile 83 (%42,5), kültürde üreme ile 72 (%36,9), hastaya tanı konulduğu saptandı. Tedavi ortanca süresi tüberküloz spondilodiskitinde 450 gün (240-1440 gün), brusellar spondilodiskitte 210 gün (36-720 gün) ve piyojenik spondilodiskitte 150 gün (15-960 gün) olarak saptandı. Cerrahi tedavinin tüberküloz spondilodiskitinde 35 (%63,6), brusellar spondilodiskitte 3 (%3,5) ve piyojenik spondilodiskitte 72 (%36,9) hastaya yapıldığı saptandı. Tedavi sonrası tüm hastaların 204 (%60,7)'ünde sekelsiz iyileşme görüldü. Spondilodiskit tanısı, şüphe duyulan hastalarda modern tıp yöntemlerinin birlikte kullanılmasını gerektirir. Uygun ve yeterli süre tedavi için etkenin saptanması önemlidir.
Since the clinical findings of spondylodiscitis are not specific, there may be difficulties and delays in diagnosis. It is essential to treat the causative agent for the success of the treatment. In our study, the clinical manifestations, diagnostic methods and treatment options of patients with spondylodiscitis were examined and it was aimed to get an early diagnosis in order to reduce the morbidity of the patients and to determine effective treatment options. In our study, patients with a diagnosis of infectious spondylodiscitis aged 18 years and older who were followed up in the Infectious Diseases Clinic and Outpatient Clinic of Bursa Uludağ University Faculty of Medicine between January 1, 2000 and December 31, 2020 were evaluated retrospectively. Our study included 336 patients. Of the patients, 55 (16.4%) were diagnosed with tuberculous spondylodiscitis, 86 (25.6%) were diagnosed with brucellar spondylodiscitis, 195 (58%) were diagnosed with pyogenic spondylodiscitis. Of the pyogenic spondylodiscitis patients, 107 (n=195, 54.9%) were community-acquired, and 88 (n=195, 45.1%) had postoperative spondylodiscitis. The most common symptom among all groups was low back pain (77%). The most frequently affected vertebrae were thoracic vertebra (45.5%) in tuberculous spondylodiscitis, lumbar spine (51.1%) in brucellar spondylodiscitis and lumbar spine (53.8%) in pyogenic spondylodiscitis. It was found that interventional procedure was performed in 53 (96.3%) of 55 patients for the diagnosis of tuberculosis spondylodiscitis, histopathology supported the diagnosis in 32 (58%) of the patients and there was growth in the culture in 19 (34.5%) of them. Brucellar spondylodiscitis was diagnosed in 82 (93%) patients with brucella agglutination test and 12 (13.9%) patients with growth in culture. In the diagnosis of pyogenic spondylodiscitis, interventional procedures were performed in 94 (48.2%) of 195 patients, 83 (42.5%) patients were diagnosed with histopathology and 72 (36.9%) patients were diagnosed with growth in culture. The median duration of treatment was 450 days (240-1440 days) in tuberculous spondylodiscitis, 210 days (36-720 days) in brucellar spondylodiscitis and 150 days (15-960 days) in pyogenic spondylodiscitis. It was determined that surgical treatment was applied to 35 (63.6%) patients in tuberculous spondylodiscitis, 3 (3.5%) patients in brucellar spondylodiscitis and 72 (36.9%) patients in pyogenic spondylodiscitis. After the treatment, 204 (60.7%) of all patients recovered without sequelae. The diagnosis of spondylodiscitis requires the use of modern medical methods in suspected patients. It is important to determine the causative agent for an appropriate and sufficient duration of treatment.
Since the clinical findings of spondylodiscitis are not specific, there may be difficulties and delays in diagnosis. It is essential to treat the causative agent for the success of the treatment. In our study, the clinical manifestations, diagnostic methods and treatment options of patients with spondylodiscitis were examined and it was aimed to get an early diagnosis in order to reduce the morbidity of the patients and to determine effective treatment options. In our study, patients with a diagnosis of infectious spondylodiscitis aged 18 years and older who were followed up in the Infectious Diseases Clinic and Outpatient Clinic of Bursa Uludağ University Faculty of Medicine between January 1, 2000 and December 31, 2020 were evaluated retrospectively. Our study included 336 patients. Of the patients, 55 (16.4%) were diagnosed with tuberculous spondylodiscitis, 86 (25.6%) were diagnosed with brucellar spondylodiscitis, 195 (58%) were diagnosed with pyogenic spondylodiscitis. Of the pyogenic spondylodiscitis patients, 107 (n=195, 54.9%) were community-acquired, and 88 (n=195, 45.1%) had postoperative spondylodiscitis. The most common symptom among all groups was low back pain (77%). The most frequently affected vertebrae were thoracic vertebra (45.5%) in tuberculous spondylodiscitis, lumbar spine (51.1%) in brucellar spondylodiscitis and lumbar spine (53.8%) in pyogenic spondylodiscitis. It was found that interventional procedure was performed in 53 (96.3%) of 55 patients for the diagnosis of tuberculosis spondylodiscitis, histopathology supported the diagnosis in 32 (58%) of the patients and there was growth in the culture in 19 (34.5%) of them. Brucellar spondylodiscitis was diagnosed in 82 (93%) patients with brucella agglutination test and 12 (13.9%) patients with growth in culture. In the diagnosis of pyogenic spondylodiscitis, interventional procedures were performed in 94 (48.2%) of 195 patients, 83 (42.5%) patients were diagnosed with histopathology and 72 (36.9%) patients were diagnosed with growth in culture. The median duration of treatment was 450 days (240-1440 days) in tuberculous spondylodiscitis, 210 days (36-720 days) in brucellar spondylodiscitis and 150 days (15-960 days) in pyogenic spondylodiscitis. It was determined that surgical treatment was applied to 35 (63.6%) patients in tuberculous spondylodiscitis, 3 (3.5%) patients in brucellar spondylodiscitis and 72 (36.9%) patients in pyogenic spondylodiscitis. After the treatment, 204 (60.7%) of all patients recovered without sequelae. The diagnosis of spondylodiscitis requires the use of modern medical methods in suspected patients. It is important to determine the causative agent for an appropriate and sufficient duration of treatment.
Description
Keywords
Spondilodiskit, Tüberküloz, Piyojenik, Postoperatif, Brusella, Spondylodiscitis, Tuberculosis, Brucella, Pyogenic, Postoperative
Citation
Taşdemir, C. (2022). 2000-2020 yılları arasında Bursa Uludağ Üniversitesi Tıp Fakültesi Hastanesi Enfeksiyon Hastalıkları Kliniği ve polikliniğinde takip edilen enfektif spondilodiskit tanılı hastaların retrospektif incelenmesi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.