Editorial

Hematogenous Vertebral Osteomyelitis Due to Staphylococcus aureus in the Adult

Authors: Michael S. Gelfand, MD, Kerry O. Cleveland, MD

Abstract

Hematogenous vertebral osteomyelitis (HVO) is becoming increasingly common in the developed Western countries. An aging population, frequent use of intravascular catheters for diagnostic and therapeutic procedures with complicating bacteremia, hemodialysis, frequent invasive procedures, and IV drug abuse are important predisposing factors.1 Staphylococcus aureus is the most important pathogen in HVO.2 Methicillin-resistant strains of S aureus now constitute the majority of nosocomial isolates in the United States and have recently become widespread in the community as well.3 With an increase in methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, cases of MRSA HVO are likely to become more frequent, with vancomycin being increasingly utilized in the treatment of HVO. Vancomycin monotherapy of MRSA HVO is recommended in a standard infectious diseases textbook and in a recent review of osteomyelitis;4,5 however, we have reported a series of patients who developed MRSA HVO with neurologic complications while receiving vancomycin monotherapy for MRSA bacteremia.6 So what is the optimal antibiotic therapy for a patient with MRSA HVO?

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References

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