Salmonella Osteomyelitis in Adults: A Systematic Review

Abstract

The aim of this systematic review was to characterize the clinical features of adults with Salmonella osteomyelitis and summarize diagnosis and treatment methods to provide guidance for clinicians. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a literature search in the PubMed, EMBASE, and Cochrane Library databases. Article screening and data extraction were performed by two reviewers individually. All the included studies were independently evaluated by two reviewers using the Methodological Index for Non-Randomized Studies (MINORS) criteria. A total of 67 articles published between 1970 and 2019 were selected, which include 69 patients with an average age of 47.5 years (range, 18-79).The majority of cases (47.76%) occurred in immunocompetent adults without common risk factors. Aspiration and biopsy cultures were all positive in Salmonella osteomyelitis patients who underwent aspiration or biopsy. All infections were monomicrobial, and a total of 12 different serotypes were identified. The three most commonly reported Salmonella serotypes were Salmonella typhi (19 cases), Salmonella typhimurium (12 cases), and Salmonella enteritidis (11 cases). Only 12 of the 67 cases in our data (17.91%) had diarrhea symptoms, and 44 of the 67 cases (65.67%) had fever symptoms. Fifty-nine of the 67 cases (88.06%) had local inflammatory manifestations, such as erythema, swelling, and tenderness in the affected area. The commonly reported involved sites were the vertebrae, femur, and tibia. Antibiotic therapy alone was utilized in 30 cases, and 24 patients (80.00%) were eventually cured. In total, 75.68% of patients achieved satisfactory results after treatment with surgery and antibiotics. Third-generation cephalosporins were most commonly utilized, and antibiotic treatment was administered for an average of 11.3 weeks (95% CI, 8.31-14.37 weeks). Salmonella osteomyelitis should be considered in patients without any common risk factors. Aspiration or biopsy can facilitate the identification of pathogens to guide antibiotic choice. Empirical therapy with a third-generation cephalosporin is recommended until the susceptibility of the strain is determined.

Spondylodiscitis due to Salmonella Typhi: a series of four cases

“…Other common risk factors include lymphoma, diabetes mellitus, systemic lupus erythematosus, steroids, trauma, surgery and extremes of ages [ 5 ]. In a recent systematic review, cases in individuals without any apparent risk factors have been described as well [ 2 ]. Except for the fourth patient who was diabetic, the other three patients had no history of immunosuppression.…”

“…has been due to non-typhoidal Salmonella . Of the 67 cases of Salmonella osteomyelitis in a systematic review, only 19 were found to be due to S. Typhi [ 2 ]. Cases due to S. Typhi and S. Paratyphi have been reported, mainly from developing countries [ 6–8 ].…”

“…Due to a lack of clinical trials, there is no definite recommendation on the choice of antibiotic and duration of treatment. In the systematic review by Huang et al ., 78% cure rates were noted with a treatment duration of 8–14 weeks [ 2 ]. Patients were variously treated with fluoroquinolones, ceftriaxone, chloramphenicol and cotrimoxazole [ 2 ].…”

“…In the systematic review by Huang et al ., 78% cure rates were noted with a treatment duration of 8–14 weeks [ 2 ]. Patients were variously treated with fluoroquinolones, ceftriaxone, chloramphenicol and cotrimoxazole [ 2 ]. Fluoroquinolone was not used in our series as all isolates were resistant.…”

“…Since the transmission occurs by ingesting contaminated food, the disease is predominantly reported in developing countries where overcrowding and poor sanitation are common [ 1 ]. Vertebral osteomyelitis is an extremely rare extraintestinal complication of enteric fever [ 2 ]. In tropical settings, the common cause of vertebral osteomyelitis includes tuberculosis, brucellosis and pyogenic organisms like Staphylococcus spp., Streptococcus spp.…”