PYOGENIC VERTEBRAL OSTEOMYELITIS - ANALYSIS OF 20 CASES AND REVIEW

The diagnosis of vertebral osteomyelitis is easily missed, particularl y for the elderly in whom signs of sepsis may not manifest. The case r ecords of 20 patients with vertebral osteomyelitis who were treated at our hospital between January 1989 and April 1993 were reviewed. The a verage age of the patients was 72 years. Infection was most commonly d ue to intravenous cannula-related sepsis. Eighty-five percent of patie nts presented with back pain, and only 30% had a fever. Computerized t omography and magnetic resonance imaging were the most useful radiolog ical investigations; nuclear scanning was sensitive but insufficiently specific. Staphylococcus aureus was the infecting organism in 13 of 1 6 patients whose microbiological diagnosis was made by blood or bone c ultures. Six (45%) of these 13 patients were infected with methicillin -resistant S. aureus (MRSA). Nosocomial infection occurred in 12 (60%) of the patients studied, including all patients with MRSA infections. Vertebral osteomyelitis may be largely preventable if infection-contr ol aspects of intravenous cannulation are improved, attempts at reduci ng and preventing MRSA colonization are made, and therapy for bacterem ias is optimized.