Hematogenous enterococcal vertebral osteomyelitis: report of 2 cases and review of the literature

• Published in: The Journal of infection Vol. 48; no. 4; pp. 354 - 362
• Main Authors: Tarr, Philip E, Sakoulas, George, Ganesan, Anuradha, Smith, Margo A, Lucey, Daniel R
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-05-2004; Elsevier
• Subjects: Anti-Bacterial Agents - therapeutic use; Biological and medical sciences; Enterococcus; Enterococcus faecalis; Enterococcus faecalis - isolation & purification; Epidural abscess; Fatal Outcome; Female; Fundamental and applied biological sciences. Psychology; General aspects; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - microbiology; Hematogenous; Humans; Male; Medical sciences; Microbiology; Middle Aged; Osteomyelitis - drug therapy; Osteomyelitis - microbiology; Spondylodiscitis; Thoracic Vertebrae - microbiology; Vertebral osteomyelitis; Virology; Europe; Enterococcus; Enterococcus faecalis; Epidural abscess; Spondylodiscitis; Vertebral osteomyelitis; Hematogenous; Case study; Infection; Streptococcaceae; Spondylitis; Diseases of the osteoarticular system; Bacteria; Micrococcales; Tropical medicine; Spine disease; Bibliographic review; Virology
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2003.10.004

Enterococci are a major cause of bacteraemia and endocarditis and are increasingly being implicated in bone and joint infections. Hematogenous enterococcal vertebral osteomyelitis, however, has been only rarely reported. Here we present the first 2 patients from the United States and review the literature on 10 additional cases that have been published since 1967. The clinical presentation of enterococcal vertebral osteomyelitis was similar to cases due to other bacteria.
Enterococcus faecalis caused most cases, consistent with its presumably increased virulence. All enterococcal cases in the literature were reported from Europe, which may be due to epidemiological differences related to antibiotic utilization and infection control practices between the US and Europe. Nine of all 12 cases were reported since 1995, which may be consistent with the increase in occurrence of enterococcal infections in general, in association with increasing patient co-morbidities, invasive procedures, and indwelling vascular devices.