Polymicrobial skull osteomyelitis: a rare complication of subdural hematoma evacuation

Osteomyelitis of the skull (SO) is a rare condition. The infection may complicate community-acquired sinusitis, otitis, or mastoiditis, in which case, the skull base is affected most commonly. The flora typically seen in these conditions, such as Streptococcus pneumoniae and Haemophilus influenzae, tends also to be responsible for the SO. Osteomyelitis also may follow neurosurgical procedures that breach the skull, in which case, the pathogens frequently are typical cutaneous flora such as Staphylococcus aureus or coagulase-negative staphylococci.

A case report of post-neurosurgical SO and a review of the relevant English-language literature.

We report a delayed presentation of SO after craniotomy for the evacuation of a chronic subdural hematoma. Cranial tissue cultures grew Staphylococcus aureus, Corynebacterium spp., and Escherichia coli.

The isolation of Escherichia coli as an infecting organism in SO has been reported rarely and may reflect a unique pathogenesis.