Vancomycin Therapy and the Progression
Vancomycin Therapy and the Progression
Vancomycin therapy is the standard treatment for methicillin-resistant Staphylococcus aureus (MRSA), the most common cause of vertebral osteomyelitis, an increasingly frequent complication of nosocomial bacteremia. We report five recent cases suggesting that, while giving the appearance of success by conventional clinical and laboratory criteria (eg, resolution of fever and leukocytosis), vancomycin monotherapy may in fact be insufficient to prevent or reverse the progression of hematogenous MSRA vertebral osteomyelitis. A review of the literature and possible therapeutic alternatives are also discussed.
Vertebral osteomyelitis is increasingly being reported as a complication of nosocomial bacteremia. Staphylococcus aureus, often methicillin-resistant (MRSA), is the most common cause of vertebral osteomyelitis. Intravascular catheter-related nosocomial bacteremia is an important source of MRSA vertebral osteomyelitis. Vancomycin is the standard treatment for MRSA bacteremia. Prolonged treatment courses (4 to 6 weeks) are recommended if a secondary focus of infection, such as osteomyelitis, is suspected. We have recently encountered five patients with MRSA bacteremia who developed vertebral osteomyelitis and epidural phlegmon, or abscess with spinal cord compression and neurologic sequelae, despite intravenous (IV) vancomycin therapy. All five MRSA isolates were susceptible to vancomycin with a minimum inhibitory concentration (MIC) less than or equal to 1 µg/mL. Vancomycin monotherapy of MRSA bacteremia may not prevent the development of, and may not be the optimal therapy for MRSA bacteremic vertebral osteomyelitis.
Vancomycin therapy is the standard treatment for methicillin-resistant Staphylococcus aureus (MRSA), the most common cause of vertebral osteomyelitis, an increasingly frequent complication of nosocomial bacteremia. We report five recent cases suggesting that, while giving the appearance of success by conventional clinical and laboratory criteria (eg, resolution of fever and leukocytosis), vancomycin monotherapy may in fact be insufficient to prevent or reverse the progression of hematogenous MSRA vertebral osteomyelitis. A review of the literature and possible therapeutic alternatives are also discussed.
Vertebral osteomyelitis is increasingly being reported as a complication of nosocomial bacteremia. Staphylococcus aureus, often methicillin-resistant (MRSA), is the most common cause of vertebral osteomyelitis. Intravascular catheter-related nosocomial bacteremia is an important source of MRSA vertebral osteomyelitis. Vancomycin is the standard treatment for MRSA bacteremia. Prolonged treatment courses (4 to 6 weeks) are recommended if a secondary focus of infection, such as osteomyelitis, is suspected. We have recently encountered five patients with MRSA bacteremia who developed vertebral osteomyelitis and epidural phlegmon, or abscess with spinal cord compression and neurologic sequelae, despite intravenous (IV) vancomycin therapy. All five MRSA isolates were susceptible to vancomycin with a minimum inhibitory concentration (MIC) less than or equal to 1 µg/mL. Vancomycin monotherapy of MRSA bacteremia may not prevent the development of, and may not be the optimal therapy for MRSA bacteremic vertebral osteomyelitis.
