MRSA脊椎炎の治療経験

Treatment of Methicillin-resistant Staphylococcus Aureus Spondylitis

　メチシリン耐性黄色ブドウ球菌（MRSA）脊椎炎患者の臨床経過を調査し，その治療方針を検討した．対象はMRSA脊椎炎11例（血行性感染6例，術後感染5例）である．血行性感染例は全例がcompromised hostであった．保存療法抵抗性で麻痺を併発した4例に対し前方固定術を施行し，感染の沈静化が得られたが，3例で麻痺が残存した．保存療法で沈静化したのは1例のみであり，残りの1例は保存療法中に合併症で死亡した．術後感染例全例で脊椎インプラントを使用していた．感染早期にインプラントを抜去した2例は6カ月以内に沈静化したが，抜去が遅れた2例で感染が遷延化した．インプラントを抜去しなかった1例は敗血症で死亡した．血行性感染例では，保存療法で十分な治療効果が得られない場合，compromised hostでも早期に手術療法を行うべきである．術後感染例では可及的早期のインプラント抜去が必要である．

　The purpose of this study was to propose the optimal management for MRSA spondylitis. The records of 11 patients with MRSA spondylitis were reviewed. Six of these 11 patients had a hematogenous infection, and five had postoperative infection. All patients with hematogenous infection were immunocompromised hosts. Four patients with hematogenous infection who developed paralysis underwent anterior spinal fusion, however, paralysis persisted in 3 patients. The infection was eradicated in one case with only conservative therapy. All five patients with postoperative infection had previously undergone spinal instrumentation surgery. In four patients who had lumbar infection, instruments had to be removed. In one patient who had cervical infection, the implant could not be removed due to the patient's poor general condtion, and the patient died of sepsis. Our results indicated that for immunocompromised hosts with spondylitis, MRSA infection should be considered, and appropriate intravenous antibiotics should be administered immediately. Early surgical debridement is recommended when such antibiotic treatment is ineffective. In postoperative MRSA infection, early and complete removal of the instrumentation is necessary.