Purpose: To review and evaluate the management of 14 patients with pyogenic vertebral osteomyelitis at National University Hospital, Singapore between 1998 and 2001.
Methods: Demographic pattern, predisposing factors, clinical presentation, co-morbidities, microbiology, treatment, and complications of 14 patients were retrospectively reviewed.
Results: The mean age at presentation was 62.5 years and the male to female ratio was 6:1. The mean follow-up duration was 12.5 months. The most common predisposing condition was diabetes mellitus (n=5). The most common site of infection was the lumbar spine (n=8), followed by the thoracic (n=4) and cervical (n=2) spine. Staphylococcus aureus was the most common causative organism isolated (n=9), followed by methicillin-resistant S aureus (n=3), Pseudomonas pseudomallei (n=1), and Streptococcus agalactiae (n=1). 12 patients were treated surgically: 8 by an anterior approach, 3 by a posterior approach, and one by a combination of the 2. The mean period of antibiotic use was 11.4 weeks. One patient with melioidosis involving the T9 to T11 vertebrae caused by P pseudomallei died of empyema and septicaemia 22 months after presentation.
Conclusion: Pyogenic vertebral osteomyelitis is not uncommon in the elderly, especially those with predisposing conditions such as diabetes mellitus. Computed tomography-guided needle biopsy is recommended to investigate causative microorganisms. Aggressive surgical debridement and prolonged antibiotic therapy were necessary in patients with methicillin-resistant S aureus, P pseudomallei, and S agalactiae.