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  • Title: Hematogenous methicillin-resistant Staphylococcus aureus spondylodiscitis.
    Author: Al-Nammari SS, Lucas JD, Lam KS.
    Journal: Spine (Phila Pa 1976); 2007 Oct 15; 32(22):2480-6. PubMed ID: 18090089.
    Abstract:
    STUDY DESIGN: Retrospective case series. OBJECTIVE: To determine relevant demographics, clinical presentations, and outcomes of this condition. SUMMARY OF BACKGROUND DATA: 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. CONCLUSION: This is a devastating condition with high mortality and morbidity.
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