BACTEREMIC STAPHYLOCOCCUS-AUREUS SPONDYLITIS

Background: The incidence of hematogenous Staphylococcus aureus osteom yelitis of the vertebral column is rapidly increasing and few studies dealing with the diagnosis, treatment, and outcome of this severe dise ase are available. Methods: Based on a nationwide registration, the cl inical and bacteriological data were reviewed from 133 cases with a po sitive blood culture for S aureus and symptoms of vertebral osteomyeli tis in Denmark for the period 1980 to 1990.Results: The 133 cases of v ertebral S aureus osteomyelitis reviewed were mainly community-acquire d infections (82%) in older patients (median age, 65 years) and often occurred with underlying diseases. Both symptoms and laboratory values were relatively unspecific. Bone scan methods proved to be more optim al for diagnosis of vertebral S aureus osteomyelitis in the early stag es compared with conventional radiography that proved a lack of consis tency in the formative stages. The infection was mostly (70%) localize d in the lower part of the column. The recurrence rate and rate of the rapeutic failure depended on the duration and dosage of penicillinase- stable penicillins, respectively. Patients treated with fusidic acid i n addition to penicillinase-stable penicillins had a significantly low er recurrence rate. Based on these findings, we recommend treatment wi th penicillinase-stable penicillins and fusidic acid for a total of 8 weeks, with a daily dosage of penicillinase-stable penicillins higher than 4 g. Conclusions: The diagnosis of vertebral S aureus osteomyelit is based on clinical findings is difficult to ascertain. Bone scans ar e necessary because radiographic methods do not detect disease as earl y. Treatment with penicillinase-stable penicillins, at least 4 g/d for at least 8 weeks, is recommended.