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Beitragstitel Infective spondylitis with epidural abscess-formation caused by Aerococcus urinae: a case report
Beitragscode P094
  1. Benjamin Martens Kantonsspital St. Gallen Vortragender
  2. Miscia Vincenti Kantonsspital St. Gallen
  3. Hannes Florianz Privatklinik Maria Hilf
  4. Carol Strahm Kantonsspital St. Gallen
  5. Fabrice Külling Klinik Gut
Präsentationsform Poster
  • A7 - Spezialgebiet 2 | Infekte
Abstract Introduction:
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.