Hematogenous methicillin-resistant Staphylococcus aureus spondylodiscitis.
METHODS
Retrospective case series.


OBJECTIVE
To determine relevant demographics, clinical presentations, and outcomes of this condition.


BACKGROUND
This is the first study looking specifically at methicillin-resistant Staphylococcus Aureus (MRSA) spondylodiscitis.


METHODS
We performed a retrospective review of patients presenting between 2000 and 2005.


RESULTS
Thirteen cases were identified. The mean age was 65 years; 85% were male. All cases presented with back pain, spinal tenderness, and systemic upset. Neurologic deficit was present initially in 39%, and 8% developed neurologic deterioration during treatment. The thoracic spine (53%) was most commonly affected, followed by the lumbar (33%), thoracolumbar junction (7%), and cervical spine (7%); 16% of cases were multilevel. The white cell count, erythrocyte sedimentation rate and C-reactive protein were elevated in all cases with means of 17.3 x 10(-9)/L, 102 mm/h, and 236 mg/L, respectively. Radiologic diagnosis was established with MRI in all cases. The most common risk factors were diabetes mellitus (62%), malnourishment (54%), cirrhosis (31%), end-stage renal failure (15%), and intravenous drug use (15%). Multiple risk factors were present in 76% of cases, and only 15% had no identifiable risk factors. The main sources of sepsis were intravenous catheters (23%), urinary tract (15%), and intravenous drug use (15%). Treatment consisted of intravenous vancomycin monotherapy for a mean period of 4 weeks followed by oral combination or monotherapy antimicrobials for a mean period of 8 weeks. Operative intervention was required in 38% of cases. At 6 months, 54% of cases were clinically free of infection, 38% had died, and 8% required ongoing treatment. Neurologic deficit was present in 50% of survivors. At 1 year, 29% of survivors had MRSA bacteremia and spondylodiscitis recurrence.


CONCLUSIONS
This is a devastating condition with high mortality and morbidity.
Al-Nammari
Shafic Said
SS
Guy's & St. Thomas' Hospitals NHS Trust, London, United Kingdom. shafic2@hotmail.com
Lucas
Jonathan D
JD
Lam
Khai S
KS
D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D015299:Discitis / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000382:microbiology* / Q000503:physiopathology; D017678:Sex Distribution; D013131:Spine / Q000382:microbiology / Q000473:pathology*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D013211:Staphylococcus aureus / Q000187:drug effects*; D015996:Survival Rate; D014640:Vancomycin / Q000627:therapeutic use
D000890:Anti-Infective Agents; D014640:Vancomycin