Abstract
BackgroundPneumococcal vertebral osteomyelitis (PVO) is a rare disease whose clinical characteristics have not been clarified. This study aimed to investigate the clinical features and outcomes of patients with PVO.MethodsWe retrospectively evaluated all adult patients diagnosed with PVO at three teaching hospitals in Japan from January 2003 to December 2011. All cases were identified through a review of the medical records of patients with invasive pneumococcal disease (IPD).ResultsAmong 208 patients with IPD, we identified 14 with PVO (6.4%; 95% CI, 3.5–10%). All 14 patients (nine male, five female; median age 69 years) had acquired PVO outside the hospital and had no recent history of an invasive procedure or back injury. Five patients (36%) had diabetes mellitus, and four (29%) had heavy alcohol intake. Fever (n = 13; 93%) or back pain/neck pain (n = 12; 86%) were present in most patients. The lumbar spine was affected in nine patients (64%) but the cervical spine was the site of infection in four patients (29%). All patients except one had a positive blood culture for Streptococcus pneumoniae, and there were no distant infected sites in most patients (n = 10; 71%). Intravenous beta-lactam therapy was initiated within 1 week after the onset of symptoms in 11 patients (79%). No patients died within 30 days, but one patient died from aspiration pneumonia on day 37 after admission.ConclusionsPVO was relatively common among adult patients with IPD, and mortality was low in this study. S. pneumoniae may be the causative pathogen of vertebral osteomyelitis, especially among community-onset cases without a history of invasive procedures or back injury.
Highlights
Pneumococcal vertebral osteomyelitis (PVO) is a rare disease whose clinical characteristics have not been clarified
Data from 208 cases were reviewed for infective sources. This resulted in identification of 14 patients (6.4%; 95% CI, 3.5–10%) with PVO, followed by 129 with pneumonia or empyema, 25 with primary bacteremia, 23 with meningitis, seven with joint infections and 10 with other infections
While cases of other invasive pneumococcal disease (IPD) were relatively frequent during the winter season, this trend was not seen in the PVO group (50% vs. 14% for winter occurrences, P = 0.01)
Summary
Pneumococcal vertebral osteomyelitis (PVO) is a rare disease whose clinical characteristics have not been clarified. This study aimed to investigate the clinical features and outcomes of patients with PVO. Streptococcus pneumoniae is an important pathogen that is the main cause of community-acquired pneumonia [1], meningitis [2], sinusitis [3] and otitis media [4]. S. pneumoniae was the third most common pathogen in bacterial arthritis, identified in 6% of cases [5]. Pneumococcal vertebral osteomyelitis (PVO) is a very rare disease, and the incidence has not been described in. We set out to determine the clinical epidemiology of patients with PVO in a 9-year retrospective review of cases of invasive pneumococcal disease (IPD) at three teaching hospitals with tertiary emergency medical centers in Japan
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