Vertebral Osteomyelitis and Infective Endocarditis Co-Infection

Abstract

Many cases of vertebral osteomyelitis (VO) and infective endocarditis (IE) co-infection have been reported, and it has been recognized that attention should be paid to the possibility of both diseases co-existing during diagnosis and treatment. However, the incidence, clinical status, and outcomes of IE in patients with VO remain unclear. For this study, the eligibility criteria for patient recruitment included all cases of VO at the five medical university hospitals. Patients with a history of spinal surgery were excluded from this study. Echocardiography was routinely performed for all patients with VO. IE was diagnosed according to the modified Duke criteria for definite endocarditis. We analyzed demographic data, underlying conditions, clinical features, laboratory data, echocardiography, radiologic images, treatments, and outcomes. VO was diagnosed in 59 patients and IE was diagnosed in seven patients (12%). There were no significant differences in the clinical features, microorganisms, or radiographic status between the VO-IE co-infection and VO-only groups. In this study, using routine echocardiography for VO, the IE prevalence was 12%. The lack of specific clinical features and laboratory findings may hamper the diagnosis of IE. Therefore, clinicians are always required to suspect IE in patients with VO.

Contribution of Positron Emission Tomography-Computed Tomography (PET/CT) to the Diagnosis of Endocarditis Due to an Infected Pacemaker Associated With Spondylodiscitis

“…Nevertheless, in the present case, the multiple adjustments of the pacemaker on the same side cannot preclude the device infection from existing skin flora. It has been reported that a six-week antimicrobial treatment of spondylodiscitisassociated IE has been efficient without the increased risk of relapse [17][18][19]. Hence, the present patient was treated with an appropriate antimicrobial combination for 40 days, followed by the installation of a new pacemaker on the contralateral side, Regarding CDRIE, most studies recommend device and lead replacement for radical treatment as in the present case [20].…”

“…The pathogenesis connecting the two infections remains unclear and a matter of debate. However, irrespective of the exact pathogenesis, the association of spondylodiscitis and IE should always be considered, especially in cases with suspicious relevant symptoms [15,[17][18][19]. Nevertheless, in the present case, the multiple adjustments of the pacemaker on the same side cannot preclude the device infection from existing skin flora.…”

A case of Staphylococcus epidermidis osteomyelitis in the absence of spine hardware

“…Several recent studies detected infective endocarditis (IE) in 10–15 % of patients with vertebral osteomyelitis. [13] , [14] Other studies have reported coinfection rates as high as 33 % with variation due to patient demographics (higher rates of IE were reported in older and male patients) and sensitivity of imaging modalities. [15] Infective endocarditis (IE) should be considered in all cases of vertebral osteomyelitis especially in elderly patients and those with a history of valvulopathy.…”

A case of recurrent osteomyelitis due to retained micro-catheter after cerebral angiography

“…The lumbar spine is the most prevalent site of pyogenic infection involvement, followed by the thoracic, cervical, and sacral regions [5] . Vertebral osteomyelitis is frequently linked to infections in distant sites, including urinary tract infections, infective endocarditis (IE), intestinal infections, and skin infections through the hematogenous pathway [6] . The rise in the occurrence of hematogenous vertebral osteomyelitis (HVO) among young patients is connected to the expanding population of intravenous drug users and endocarditis.…”

“…Hence, clinicians, particularly spine surgeons and internal medicine physicians dealing with VO cases, must maintain a heightened awareness of IE to prevent overlooking this significant complication. Regular echocardiograms and multiple sets of blood cultures should be routinely conducted to ensure timely diagnosis and implement supportive therapy, which is crucial for minimizing morbidity and mortality [6] . Also, in individuals suspected of hematogenous vertebral osteomyelitis and having an intravascular catheter or device, it is advisable to collect blood cultures.…”