Streptococcal and Enterococcal Spondylodiscitis (Vertebral Osteomyelitis). High Incidence of Infective Endocarditis in 50 Cases

DENIS MULLEMAN, PEGGY PHILIPPE, ERIC SENNEVILLE, CHANTAL COSTES, LISBETH FAGES, XAVIER DEPREZ, RENÉ-MARC FLIPO, and BERNARD DUQUESNOY

ABSTRACT.

Objective. To characterize the clinical, biological, and imaging features and outcomes of patients with streptococcal and enterococcal spondylodiscitis (SESD).

Methods. This retrospective study of patients with SESD was carried out in 2 departments of rheumatology from 1990 through 2002. Comparison was made with cases of staphylococcal spondylodiscitis (SSD) seen during the same period, excluding postoperative cases.

Results. Fifty cases of SESD were reviewed and compared with 86 cases of SSD. The main finding was a higher frequency of concomitant infective endocarditis in patients with SESD (11/42 vs 1/37; p = 0.009). Evidence of inflammation, imaging features, and neurological impairment at admission appeared to be less severe in SESD, but the difference did not reach statistical significance. Duration of treatment was shorter in SESD than in SSD (105 ± 26 days vs 130 ± 49 days; p = 0.003).

Conclusion. Our study confirms the high incidence of infective endocarditis (26%) during SESD. Clinicians must look for predisposing factors and clinical abnormalities in patients with spondylodiscitis whenever a streptococcal or enterococcal agent is identified. Echocardiography should be performed as routine in such situations. (J Rheumatol 2006;33:91-7)

Key Indexing Terms:

VERTEBRAL OSTEOMYELITIS
STREPTOCOCCUS
ENTEROCOCCUS
ENDOCARDITIS

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From the Department of Rheumatology, University Hospital of Lille, Lille; Department of Infectious Diseases, Tourcoing Hospital, Tourcoing; and Department of Rheumatology, Valenciennes Hospital, Valenciennes, France.

D. Mulleman, MD, Department of Rheumatology, University Hospital of Lille, current assignment, Department of Rheumatology, François-Rabelais University, Tours; P. Philippe, MD; R-M. Flipo, MD; B. Duquesnoy, MD, Department of Rheumatology, University Hospital of Lille; E. Senneville, MD, Department of Infectious Diseases, Tourcoing Hospital; C. Costes, MD; L. Fages, MD; X. Deprez, MD, Department of Rheumatology, Valenciennes Hospital.

Address reprint requests to Dr. D. Mulleman, Department of Rheumatology, Trousseau Hospital, F-37044 Tours cedex 9, France. E-mail: mulleman@med.univ-tours.fr

Accepted for publication August 2, 2005.

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