Diagnosis and Treatment of Klebsiella Pneumoniae Combined with Enterobacter Cloacae in Lumbar Intervertebral Space Infection

CHENG Han-wen; WU Zhao-juan; LIU Zhuo-jie; WU Hao-yu; ZHANG Di; WANG Ning; LI Chun-hai

doi:10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0316

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Diagnosis and Treatment of Klebsiella Pneumoniae Combined with Enterobacter Cloacae in Lumbar Intervertebral Space Infection

Clinical Research | 更新时间：2024-02-19

- Diagnosis and Treatment of Klebsiella Pneumoniae Combined with Enterobacter Cloacae in Lumbar Intervertebral Space Infection
- Journal of Sun Yat-sen University(Medical Sciences) Vol. 44, Issue 3, Pages: 485-489(2023)
- 作者机构：
  
  1.中山大学孙逸仙纪念医院骨外科，广东广州510120
  2.西南医科大学临床医学院，四川泸州 646000
  3.中山大学孙逸仙纪念医院外科教研室广东广州510120
- 作者简介：
  
  LI Chun-hai；E-mail： lichhai@mail.sysu.edu.cn
- 基金信息：
- DOI：10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0316
  CLC： R681.5;R378
- Received：31 October 2022，
  
  Published：20 May 2023
- 稿件说明：
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程翰文,吴朝娟,刘卓劼等.腰椎间隙感染肺炎克雷伯菌合并阴沟肠杆菌的诊疗[J].中山大学学报（医学科学版）,2023,44(03):485-489.

CHENG Han-wen,WU Zhao-juan,LIU Zhuo-jie,et al.Diagnosis and Treatment of Klebsiella Pneumoniae Combined with Enterobacter Cloacae in Lumbar Intervertebral Space Infection[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(03):485-489.
程翰文,吴朝娟,刘卓劼等.腰椎间隙感染肺炎克雷伯菌合并阴沟肠杆菌的诊疗[J].中山大学学报（医学科学版）,2023,44(03):485-489. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0316.

CHENG Han-wen,WU Zhao-juan,LIU Zhuo-jie,et al.Diagnosis and Treatment of Klebsiella Pneumoniae Combined with Enterobacter Cloacae in Lumbar Intervertebral Space Infection[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(03):485-489. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0316.

摘要

目的

罕见的原发性腰椎间隙感染肺炎克雷伯菌合并阴沟肠杆菌的临床诊疗初探，为此类罕见脊柱感染诊疗提供临床经验。

方法

腰痛伴左下肢麻痛7月余、加重1周余的老年男性患者，经实验室、影像学检查，诊断为腰椎间盘突出症，入院后症状急性加重，复查腰椎增强MRI示L3/4椎间隙后部局部强化信号，VAS评分9分，腰部JOA评分6分。实施腰椎后路L3/4、L4/5椎间盘摘除＋cage植骨融合＋L3-L5椎弓根钉棒内固定术，并留取术中L3/4椎间盘标本备细菌培养。

结果

细菌培养结果回示肺炎克雷伯杆菌及阴沟肠杆菌感染，术后敏感抗生素治疗6周，患者在术后半年的随访中获得痊愈。

结论

对临床表现为急性剧烈腰痛或下肢疼痛的中老年患者，在常规实验室、影像学检查提示腰椎退行性疾病的同时应考虑脊柱感染可能。

Abstract

Objective

To explore the clinical diagnosis and treatment of rare primary lumbar intervertebral space infection with Klebsiella pneumoniae and Enterobacter cloacae， and provide clinical experience for the diagnosis and treatment of this rare spinal infection.

Methods

An elderly male patient with low back pain and numbness in the left lower extremity for more than 7 months， which aggravated for more than 1 week， was diagnosed with lumbar disc herniation after laboratory and imaging examinations. After admission， the symptoms became acutely aggravated， and re-examination of lumbar enhanced MRI showed local enhancement at the posterior edge of the L3/4 intervertebral space. The VAS score was 9 points， and the lumbar JOA score was 6 points. A posterior lumbar interbody fusion of L3-L5 was performed， and L3/4 intervertebral disc specimens were collected during the operation for bacterial culture.

Results

Bacterial culture results showed Klebsiella pneumoniae and Enterobacter cloacae infection. The patient was treated with sensitive antibiotics for 6 weeks after the operation， and the patient was cured during the follow-up of half a year after the operation.

Conclusion

For middle-aged and elderly patients with clinical manifestations of acute severe low back pain or lower extremity pain， the possibility of spinal infection should be considered when routine laboratory and imaging examinations suggest lumbar degenerative diseases.

关键词

Keywords

references

Brooks CA ， Mahajan S ， Beresford R ， et al . Thoracic spondylodiscitis secondary to Klebsiella oxytoca urosepsis-a case report ［J］. J Spine Surg ， 2022 ， 8 （ 1 ）： 54 - 61 .

Ikeda M ， Mizoguchi M ， Oshida Y ， et al . Clinical and microbiological characteristics and occurrence of Klebsiella pneumoniae infection in Japan ［J］. Int J Gen Med ， 2018 ， 11 ： 293 - 299 .

万超，谢炜星，晋大祥 . 腰椎肺炎克雷伯菌感染1例报告［J］. 中国脊柱脊髓杂志， 2016 ， 26 （ 6 ）： 568 - 570 .

Wan C ， Xie WX ， Jin DX ， et al . The infection of the lumbar vertebrae with Klebsiella pneumoniae： a case report ［J］. Chin J Spine Spinal Cord ， 2016 ， 26 （ 6 ）： 568 - 570 .

Suratwala SJ ， Kondra K ， Cronin M ， et al . Malignant peripheral nerve sheath tumor of the sciatic nerve presenting with leg pain in the setting of lumbar scoliosis and spinal stenosis ［J］. Spine Deform ， 2020 ， 8 （ 2 ）： 333 - 338 .

Duarte RM ， Vaccaro AR . Spinal infection： state of the art and management algorithm ［J］. Eur Spine J ， 2013 ， 22 （ 12 ）： 2787 - 2799 .

郑兴平，赵俊华，钟建 . 34例腰椎间隙感染的诊断与治疗分析［J］. 重庆医学， 2012 ， 41 （ 25 ）： 2586 - 2588 .

Zheng XP ， Zhao JH ， Zhong J . Analysis on diagnosis and treatment in 34 case of lumbar intervertebral space infection ［J］. Chongqing Medicine ， 2012 ， 41 （ 25 ）： 2586 - 2588 .

Ozsari T ， Bora G ， Ozdemir OM ， et al . A neonatal septic arthritis case caused by Klebsiella pneumoniae： A case report ［J］. J Clin Diagn Res ， 2016 ， 10 （ 2 ）： SD01 - 02 .

Premathilake PNS ， Kularatne WKS ， Jayathilake JPK ， et al . Klebsiella pneumoniae liver abscess： a case report ［J］. J Med Case Rep ， 2018 ， 12 （ 1 ）： 367 .

Ojeda Gómez JSA ， Carrillo Bayona JA ， Morales Cifuentes LC . Septic pulmonary embolism secondary to Klebsiella pneumoniae Epididymitis： Case report and literature review ［J］. Case Rep Radiol ， 2019 ； 2019 ： 5395090 . doi： 10.1155/2019/5395090 http://dx.doi.org/10.1155/2019/5395090 .

Zhao J ， Huo T ， Luo X ， et al . Klebsiella pneumoniae-related brain abscess and meningitis in adults： Case report ［J］. Medicine （Baltimore）， 2022 ， 101 （ 2 ）： e28415 .

孟飞，张迪，张计成，等 . 阴沟肠杆菌引起的原发性颈椎间盘炎一例［J］. 中华临床感染病杂志， 2015 ， 8 （ 2 ）： 167 - 169 .

Meng F ， Zhang D ， Zhang JC ， et al . Primary cervical discitis caused by Enterobacter cloacae： report of one case ［J］. Chin J Clin Infect Dis ， 2015 ， 8 （ 2 ）： 167 - 169 .

Wengrofsky P ， Soleiman A ， Benyaminov F ， et al . Enterobacter cloacae device endocarditis： case report， scoping study， and guidelines review ［J］. Cardiol Vasc Res （Wilmington）， 2019 ， 3 （ 3 ）. doi ： 10. 33425/2639-8486.1050 http://dx.doi.org/10.33425/2639-8486.1050 .

Huang J ， Xu Q ， Liu F ， et al . Enterobacter cloacae infection of the shoulder in a 52-year-old woman without apparent predisposing risk factor： a case report and literature review ［J］. BMC Infect Dis ， 2021 ， 21 （ 1 ）： 13 .

王蕾蕾，王明贵，杨帆 . 肺炎克雷伯菌逃避中性粒细胞免疫的机制［J］. 中国感染与化疗杂志， 2022 ， 22 （ 2 ）： 241 - 243 .

Wang LL ， Wang ML ， Yang F . Potential mechanism underlying Klebsiella pneumoniae escaping neutrophils defense ［J］. Chin J Infect Chemother ， 2022 ， 22 （ 2 ）： 241 - 243 .

Dai G ， Li S ， Yin C ， et al . Culture-negative versus culture-positive in pyogenic spondylitis and analysis of risk factors for relapse ［J］. Br J Neurosurg ， 2021 ； 1 - 5 .

Berbari EF ， Kanj SS ， Kowalski TJ ， et al . 2015 Infectious Diseases Society of America （IDSA） clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults ［J］. Clin Infect Dis ， 2015 ； 61 （ 6 ）： e26 - e46 .

于峥嵘，李淳德，施学东，等 . 成人原发性脊柱非特异性感染的诊断和治疗［J］. 中华外科杂志， 2011 （ 11 ）： 1054 - 1055 .

Yu ZR ， Li CD ， Shi XD ， et al . Diagnosis and treatment of primary spinal nonspecific infection in adults ［J］. Chin J Surg ， 2011 （ 11 ）： 1054 - 1055 .

朱小龙，徐卫星，刘杰 . 椎间隙感染的诊断与治疗进展［J］. 中国骨伤， 2016 ， 29 （ 9 ）： 870 - 874 .

Zhu XL ， Xu WX ， Liu J . Advances in diagnosis and treatment of intervertebral space infection ［J］. J Chin Orthop Traumatol ， 2016 ， 29 （ 9 ）： 870 - 874 .

陶帅，姜宏，王铠，等 . 破裂型与未破裂型腰椎间盘突出组织超微结构对比观察［J］. 临床骨科杂志， 2014 ， 17 （ 5 ）： 604 - 607 .

Tao S ， Jiang H ， Wang K ， et al . Ruptured and unruptured comparative study of lumbar disc tissue ultrastructure ［J］. Journal of Clinical Orthopaedics用简写， 2014 ， 17 （ 5 ）： 604 - 607 .

Torres C ， Zakhari N . Imaging of spine infection ［J］. Semin Roentgenol ， 2017 ， 52 （ 1 ）： 17 - 26 .

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