title: Pneumococcal vertebral osteomyelitis at three teaching hospitals in Japan, 2003-2011: analysis of 14 cases and a review of the literature.
abstract: BACKGROUND
  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.
  
  
  METHODS
  We 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).
  
  
  RESULTS
  Among 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.
  
  
  CONCLUSIONS
  PVO 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.
authors.affiliation: Department of Clinical Laboratory Medicine, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba 305-8558, Japan. hsuzuki@tmch.or.jp.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Suzuki
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shichi
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
authors.forename: Hiroichi
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Maeno
authors.forename: Hidenori
authors.initials: H
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015299:Discitis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*