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.