Vertebral osteomyelitis in northern Spain. Report of 62 cases

Objective The records of 62 patients with clinical and radiographic evidenc e of vertebral osteomyelitis and positive bacteriological diagnosis, seen b etween 1979 and 1996 were reviewed in order to gather data on the epidemiol ogy and the clinical pattern displayed by patients with this condition in n orthern Spain. Results Staphylococcus aureus (15 cases), Mycobacterium tuberculosis (15 ca ses) and Brucella melitensis (13 cases) were the microorganisms most freque ntly found in our patient series. After improvement of the sanitary and hyg ienic control of food products, the role of Brucella melitensis is decreasi ng as a causative agent (only 3 cases in the last 6 years). Stapylococcus e pidermidis, present in 4 cases (6.6%), should be suspected in elderly patie nts with previous intravenous cannulations (3 of 4 cases). The most frequen t risk factors were alcoholism (7 cases), chronic hepatic disease (7 cases) , diabetes (6 cases) and previous surgery (6 cases). Delay in diagnosis was high (the mean number of days between the onset of symptoms and diagnosis was 125). The lumbar region was the most commonly affected site. Neurologic involvement was present in 10 patients on admission (16%). ESR was > 50 mm /hr in a high number of cases. Blood cultures were found to be the most val uable routine test. Plain x-rays were normal in 10 patients (16%); in 6 of them Staphylococcus aureus was the responsible organism. Other imaging moda lities showed a high sensitivity. Surgical drainage was necessary in 12 ind ividuals (in 7 due to Mycobacterium tuberculosis). Outcome was good in the majority of cases: only 2 patients with associated endocarditis died. Neuro logic sequelae were present in another 3 patients. Conclusion Vertebral osteomyelitis can be caused by a variety of pathogens. Therefore, bacteriological studies are necessary to establish the etiologi c diagnosis and determine the specific antimicrobial treatment required.