PENICILLIN - INTERMEDIATE-RESISTANT PNEUMOCOCCAL SPONDYLODISCITIS

Pneumococcal osteomyelitis probably was more common in the pre-antibio tic era, but currently is rare. Sickle-cell disease and, possibly, bon e trauma and advanced age are predisposing factors for pneumococcal os teomyelitis. Bone infection usually occurs as a result of hematogenous spread from an infective focus, which often cannot be identified. In patients without evidence of other focci of infection, pneumococcal sp ondylodiscitis probably is caused by ''primary'' pneumococcal bacterie mia, originating in the oropharynx, especially if the patient has alte rations that disrupt the oropharyngeal mucose. Whereas early in the an tibiotic era, all Streptococcus pneumoniae strains were susceptible to penicillin, resistance to this antibiotic is on the vise, and in many parts of the world, it has emerged as a major problem. We report the case of a young patient with penicillin-resistant pneumococcal vertebr al and intervertebral disk disease who had no evidence of pneumococcal infection elsewhere, and we discuss the possible mechanism of infecti on. We also review briefly the resistance to penicillin of S. pneumoni ae and the treatment of choice. (C) 1997 Elsevier Science Inc.