title: Reactivation of dormant lumbar methicillin-resistant Staphylococcus aureus osteomyelitis after 12 years.
abstract: The adequate treatment of methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis has intrigued clinicians for some time. As the resistance of these pathogens, coupled with the increase in community-acquired cases, continues steadily to rise, clinicians are finding it useful to employ multi-modal approaches for efficacious treatment. The authors present a single case report of a patient with recurrent MRSA osteomyelitis, lumbar paraspinal and epidural abscess. He was found to have decreased muscle strength and was hyporeflexic in the involved extremity. Serum testing demonstrated MRSA bacteremia. Neuroimaging studies revealed evidence of paraspinal abscess and a presumed herniated nucleus pulposus at the L5/S1 interspace with significant nerve root compromise. Despite antimicrobials, his symptoms persisted, necessitating surgical exploration. At surgery, paraspinal and epidural abscesses were encountered and debrided; however, no herniated disc was visualized. This case demonstrates the diagnostic and therapeutic dilemmas with which these lesions present. We postulate that the MRSA osteomyelitis/discitis pathogens were walled off in the disc space and subsequently inoculated the soft tissues with ensuing bacteremia. We concur that antimicrobial treatment should be the first line of therapy for these patients; however, surgical debridements and cautious spinal instrumentation should be employed where appropriate.
authors.affiliation: Bromenn Regional Medical Center, Department of Surgery, Section of Neurosurgery, Normal, IL, USA. qspine@yahoo.com
authors.forename: Qualls E J
authors.initials: QE
authors.lastname: Stevens
authors.forename: Jason M
authors.initials: JM
authors.lastname: Seibly
authors.forename: Ying H
authors.initials: YH
authors.lastname: Chen
authors.forename: Rob D
authors.initials: RD
authors.lastname: Dickerman
authors.forename: Jerry
authors.initials: J
authors.lastname: Noel
authors.forename: Keith A
authors.initials: KA
authors.lastname: Kattner
mesh_terms: D000038:Abscess / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D000081:Acetamides / Q000627:therapeutic use; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D003646:Debridement; D004359:Drug Therapy, Combination; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000382:microbiology / Q000473:pathology; D007796:Laminectomy; D000069349:Linezolid; D008159:Lumbar Vertebrae / Q000382:microbiology* / Q000473:pathology; D008297:Male; D016106:Methicillin Resistance; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D023303:Oxazolidinones / Q000627:therapeutic use; D012008:Recurrence; D012293:Rifampin / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000601:surgery; D013211:Staphylococcus aureus; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid; D012293:Rifampin