Authors: Todd J Kowalski MD*, Kennith F Layton MD, Elie F Berbari MD, James M Steckelberg MD, Paul M Huddleston MD, John T Wald MD, Douglas R Osmon MD, MPH
Title: Propionibacterium Acnes Vertebral Osteomyelitis: Seek and Ye Shall Find?
Addresses: Mayo Clinic, Marian Hall 5, 200 1st St. SW, Rochester, MN 55905,
Purpose: To describe the clinical and radiographic findings of Propionibacterium acnes vertebral osteomyelitis at our institution.
Methods: We evaluated all cases of vertebral osteomyelitis at our institution between 1994 and 2002. Patients that met our strict case definition for P. acnes vertebral osteomyelitis were reviewed.
Results: Nine patients met our case definition. The demographic and clinical characteristics of the patients are shown in Table 1. All were male. Six patients (66%) had previously undergone an invasive procedure of the spinal column (4 patients had laminectomies and 2 patients had diskectomies) a median of 169 days (range 79 - 489) prior to diagnosis. Seven patients had at least one spinal aspiration with culture performed. Six of these patients went on to have confirmatory cultures obtained at an open surgical procedure. Susceptibility testing was obtained in 6 cases; all isolates tested were penicillin susceptible. Two of 9 patients' imaging examinations did not suggest infection. Five of 6 patients had normal erythrocyte sedimentation rates at diagnosis. Three of 6 patients' histopathology did not show evidence of infection. Eight of 9 patients were treated with parenteral antimicrobials for a median duration of 42 days. Six patients were treated with b-lactam agents (3 with ceftriaxone and 3 with cefazolin) and 2 with vancomycin. Two patients whose treatment included spinal surgery with implant placement developed relapse of their infection. The remaining seven patients had rapid improvement with antimicrobial therapy.
Discussion: Pain after an invasive spinal procedure is the most typical finding in patients with P. acnes vertebral osteomyelitis. These patients may present with atypical findings. Clinicians should be aware of the pathogenic potential of this organism and obtain appropriate anaerobic cultures to enhance diagnostic yields.