Document Detail

Bacteremic Staphylococcus aureus spondylitis.
MedLine Citation:
PMID:  9508229     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The incidence of hematogenous Staphylococcus aureus osteomyelitis of the vertebral column is rapidly increasing and few studies dealing with the diagnosis, treatment, and outcome of this severe disease are available. METHODS: Based on a nationwide registration, the clinical and bacteriological data were reviewed from 133 cases with a positive blood culture for S aureus and symptoms of vertebral osteomyelitis in Denmark for the period 1980 to 1990. RESULTS: The 133 cases of vertebral S aureus osteomyelitis reviewed were mainly community-acquired 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 optimal for diagnosis of vertebral S aureus osteomyelitis in the early stages compared with conventional radiography that proved a lack of consistency in the formative stages. The infection was mostly (70%) localized in the lower part of the column. The recurrence rate and rate of therapeutic failure depended on the duration and dosage of penicillinase-stable penicillins, respectively. Patients treated with fusidic acid in addition to penicillinase-stable penicillins had a significantly lower recurrence rate. Based on these findings, we recommend treatment with 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 osteomyelitis based on clinical findings is difficult to ascertain. Bone scans are necessary because radiographic methods do not detect disease as early. Treatment with penicillinase-stable penicillins, at least 4 g/d for at least 8 weeks, is recommended.
A G Jensen; F Espersen; P Skinhøj; N Frimodt-Møller
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of internal medicine     Volume:  158     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  1998 Mar 
Date Detail:
Created Date:  1998-03-24     Completed Date:  1998-03-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  509-17     Citation Subset:  AIM; IM    
Sector for Microbiology, Statens Serum Institut, Copenhagen, Denmark.
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MeSH Terms
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use
Diagnosis, Differential
Middle Aged
Spondylitis / diagnosis*,  drug therapy,  microbiology*,  radionuclide imaging
Staphylococcal Infections / diagnosis*,  drug therapy,  microbiology*,  radionuclide imaging
Treatment Outcome
Reg. No./Substance:
0/Anti-Bacterial Agents

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