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Penicillin--intermediate-resistant pneumococcal spondylodiscitis
J A Arranz-Caso1, N Solé, A Sanchez-Atrio
1Internal Medicine, Rehumatology, Department Príncipe de Asturias University Hospital, School of Medicine, University of Alcalá de Henares, Madrid, Spain.
Abstract:
Pneumococcal osteomyelitis probably was more common in the pre-antibiotic era, but currently is rare. Sickle-cell disease and possibly, bone trauma and advanced age are predisposing factors for pneumococcal osteomyelitis. Bone infection usually occurs as a result of hematogenous spread from an infective focus, which often cannot be identified. In patients without evidence of other focci of infection, pneumococcal spondylodiscitis probably is caused by "primary" pneumococcal bacteriemia, originating in the oropharynx, especially if the patient has alterations that disrupt the oropharyngeal mucose. Whereas early in the antibiotic era, all Streptococcus pneumoniae strains were susceptible to penicillin, resistance to this antibiotic is on the rise, and in many parts of the world, it has emerged as a major problem. We report the case of a young patient with penicillin-resistant pneumococcal vertebral and intervertebral disk disease who had no evidence of pneumococcal infection elsewhere, and we discuss the possible mechanism of infection. We also review briefly the resistance to penicillin of S. pneumoniae and the treatment of choice.
Insights
Pneumococcal osteomyelitis is rare but can be caused by penicillin-resistant Streptococcus pneumoniae. This case highlights primary bacteremia as a potential infection source, especially in vulnerable patients.
Area of Science:
- Infectious Diseases
- Orthopedics
- Microbiology
Background:
- Pneumococcal osteomyelitis, though rare today, was more common pre-antibiotics.
- Predisposing factors include sickle-cell disease, bone trauma, and advanced age.
- Infection typically arises from hematogenous spread, often from an unidentified focus.
Observation:
- Pneumococcal spondylodiscitis without other infection foci suggests primary bacteremia from the oropharynx.
- Altered oropharyngeal mucosa may facilitate primary pneumococcal bacteremia.
- A case of vertebral and intervertebral disk disease caused by penicillin-resistant Streptococcus pneumoniae is presented.
Findings:
- Streptococcus pneumoniae is increasingly resistant to penicillin, posing a significant global challenge.
- The presented case involved a young patient with vertebral and disk disease due to penicillin-resistant pneumococci.
- No concurrent pneumococcal infection was identified in the patient.
Implications:
- Understanding primary bacteremia is crucial for diagnosing and treating rare pneumococcal bone infections.
- The rise in penicillin resistance necessitates alternative treatment strategies for Streptococcus pneumoniae infections.
- This case underscores the importance of considering antibiotic resistance in clinical decision-making for osteomyelitis.