Primary skeletal infections in heroin users: a clinical characterization, diagnosis and therapy

Experience with 24 patients and 101 cases reported in the English literature demonstrate that primary skeletal infections occur in heroin users. In young individuals with no significant underlying disease, predominant involvement in the lumbar vertebrae and sternoclavicular joint, Pseudomonas aeruginosa was the dominant pathogen. Clinical manifestations, except for pain or local tenderness, and laboratory findings were of limited value. Diagnosis ultimately depended on isolation of the pathogens from either bone or joint fluid. The treatment, as indicated, was prolonged parenteral antibiotics, generally with an aminoglycoside, incision and drainage, and immobilization.