Streptococcus anginosus group and osteomyelitis: a single centre clinical experience.

PURPOSE: The Streptococcus anginosus group comprises three species of bacteria classified within the viridans streptococci. This group is known for abscess formation and endocarditis. While a variety of sites in the body claim anginosus streptococci as an agent of infection, osteomyelitis is unusual. The objective of this study was to describe a series of patients with osteomyelitis due to S anginosus group pathogens in terms of demographics, comorbidities, presentation and outcomes. STUDY DESIGN: We reviewed our database for cases of osteomyelitis caused by S anginosus organisms. Data described included demographics, comorbidities, site of infection, route of infection (haematogenous versus contiguous), laboratory data and course. RESULTS: 11 patients with S anginosus group osteomyelitis were identified. All cases arose from a contiguous anatomical site, with the exception of one haematogenous case. Five instances were related to foot osteomyelitis while three, two and one case, respectively, were related to mandibular, cranial and vertebral osteomyelitis. Seventy-five per cent of patients had associated abscesses. The mean length of antibiotic treatment was 10.9 weeks. One patient failed therapy while four others relapsed. CONCLUSIONS: Osteomyelitis due to the S anginosus group is uncommonly reported. Our case series illustrates the virulence of these organisms in the context of osteomyelitis and the importance of aggressive management.

Telavancin for the treatment of methicillin-resistant Staphylococcus aureus bone and joint infections.

This retrospective, case series describes our experience with the use of telavancin in patients with methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis and prosthetic joint infection. The primary objectives were clinical outcomes and adverse events (AEs), and a secondary outcome described microbiological susceptibility. Fourteen patients were enrolled. Median duration of therapy was 58 days, and four patients had concurrent bacteremia. End-of-treatment outcomes were available in 78% of patients, with a clinical success rate of 91%. Thirty-day and 12-month outcomes were also obtained. Seven patients experienced AEs. Infusion-related reactions were most common, and three AEs required discontinuation of therapy. All MRSA isolates had a telavancin MIC ≤0.06µg/ml, which is susceptible. This study indicates that telavancin may have a role in treatment of MRSA osteomyelitis and prosthetic joint infection. Our study describes clinical success and adverse events for long duration of therapy, up to 8 weeks.

Tigecycline in the management of osteomyelitis: a case series from the bone and joint infection (BAJIO) database.

Tigecycline is approved for cutaneous infections, intra-abdominal infections, and community-acquired pneumonia. However, pharmacokinetic data suggest therapeutic concentrations in additional sites, such as bone, despite exiguous clinical data supporting such use. Thus, the objective of this study was to analyze patients with osteomyelitis treated with tigecycline to ascertain its utility in this malady. Our database of osteomyelitis patients was surveyed for instances treated with tigecycline. Cases were evaluated in terms of adverse events and clinical success. Nineteen patients received tigecycline for osteomyelitis. Thirteen met criteria for evaluation of the primary endpoint of clinical success. The most common dose employed was 50 mg twice daily. Adverse events, however, were not statistically more likely with 100 mg administered once daily. Eleven patients (85%) achieved clinical success. Thus, congruent with pharmacokinetic data, tigecycline appeared efficacious for osteomyelitis in the majority of patients who received it. Adverse events were not correlated with dosing strategy.