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Include musculoskeletal system, especially spine, in S. aureus septicemia workup
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BELFAST, NORTHERN IRELAND — Work up for Staphylococcus aureus septicemia should include the musculoskeletal system. Further, MRI scan of the spine and pelvis is recommended as clinical examination alone may not sufficiently exclude infection, according to a presentation by D. Makki at the British Orthopaedic Association Annual Congress.
Among 137 patients who presented with methicillin-sensitive Staphylococcus aureus septicemia over 5 years at a single center, 48 patients or 35% of cases involved the musculoskeletal system as the source of the infection, Makki said.
Makki and colleagues focused on this problem in orthopedic cases because “it has been associated with high morbidity and mortality and there have not been many reports in the musculoskeletal system.”
In these cases, S. aureus septicemia was diagnosed with blood cultures and investigators also considered systemic manifestations. However, some patients in the series simply presented with being unwell and the diagnosis was determined once imaging, via ultrasound or MRI, was performed and abscesses were identified, according to Makki.
Among the 49 patients who had a total joint arthroplasty prosthesis in situ at the time of diagnosis, six implants were infected.
“The most important finding was the spine is the most common focus of infection of S. aureus septicemia with or without abscesses. We also found that back pain was a positive predictor of abscess collection. The majority of patients presented with being unwell without actually a sign of back pain,” Makki said.
The overall mortality in the series was 6% or 8 patients.
Makki showed images of spine and psoas abscesses, osteomyelitis at T7 and some cases with facet joint involvement.
Based on the study’s findings and the seriousness of this type of infection, Makki recommended including an MRI of the whole spine and pelvis in the S. aureus septicemia workup. A clinical examination alone may not be specific enough to rule out the infection, he noted.
“The CT–guided aspiration can give you an alternative to surgery in treating these patients,” Makki said. – by Susan M. Rapp
Reference:
Makki D, et al. Paper #763. Presented at: British Orthopaedic Association Annual Congress; Sept. 13-16, 2016; Belfast, Northern Ireland.
Disclosure: Makki reports no relevant financial disclosures.