Vertebral osteomyelitis due to salmonellae: report of two cases and review

We describe two patients with salmonella vertebral osteomyelitis (SVO) and review 44 cases in the English-language literature. There was male predominance (distribution, 1.7:1), primarily lumbar involvement (72% of cases), and monomicrobial etiology. Fever (87% of cases) and back pain (92% of cases) were the dominant signs and symptoms, while diarrhea was present only in 16% of cases. Blood culture was positive in 48% of cases, and stool and urine cultures were positive in 36% and 23% of cases, respectively. The overall cure rate was 61%, and the relapse rate was 9%. Infected abdominal aortic aneurysms (IAAAs) were seen exclusively in the older age group (50 years of age or older), and all deaths occurred in these patients. The mean duration of antibiotic use for patients who were cured was 60 days. Although SVO is primarily treated medically, certain cases may require individualized surgical intervention. Patients with concomitant IAAAs may need resection with thorough debridement, extraanatomic bypass grafting, and prolonged antibiotic therapy.