|Beitragstitel||Infective spondylitis with epidural abscess-formation caused by Aerococcus urinae: a case report|
In predisposed elderly, Aerococcus urinae is an underestimated urinary tract pathogen. Very few cases of balanitis, lymphadenitis, endocarditis and spondylodiscitis have been reported. In our case, infective spondylitis with epidural abscess-formation caused by A. urinae was successfully treated operatively in combination with short-term antibiotic treatment.
A 68-year-old male with lumbar pain received facet joint infiltration L4/5. 4 days after infiltration and escalating pain momentum laboratory studies showed leukocytosis and elevated CRP. Blood cultures remained sterile. MRI yielded intraspinal epidural abscess-formation L5/S1. After microscopic decompression L5/S1 because of severe pain, cefuroxime IV as empiric antibiotic therapy was started. A. urinae was grown in all biopsies. Antimicrobial treatment was changed to intravenous penicillin G and gentamicin. Urinary retention and prostate hyperplasia was found as presumed source, however, urinary status 4 days postoperatively was normal. No endocarditis was detected on serial transthoracic echocardiographies. 2 weeks post-surgery when inflammatory parameters were normal, wounds dry and the patient fully mobile, antibiotics were changed to ceftriaxone. After another 2 weeks, ceftriaxone IV was stopped and clindamycin was given orally for further 3 weeks. After an antibiotic free interval of 4 weeks, transurethral prostate resection was performed in an external clinic.
1 year after surgery, the patient presented in excellent condition without any functional impairment. No progression of osteochondrosis was detected radiologically.
To our knowledge, only 5 cases of spondylodiscitis by A. urinae have been published so far but none with an epidural abscess. In our case without endocarditis, a treatment period of 7 weeks (4 weeks IV and 3 weeks PO) in combination with surgery seemed adequate. Even though antibacterial synergy is not present in all known isolates of A. urinae, a combination therapy of penicillin G and gentamicin was applied, followed by ceftriaxone once daily IV and clindamycin orally as an outpatient. Thus, surgical therapy of epidural abscess-formation in combination with short-term use of antimicrobial treatment proved to be effective and adduced complete healing.