Department of Internal Medicine A, Shaare Zedek Medical Medicine, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Department of Internal Medicine C, Shaare Zedek Medical Medicine, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Ann Clin Microbiol Antimicrob. 2017 Oct 4;16(1):68. doi: 10.1186/s12941-017-0243-8.
Streptococcus gordonii is an infrequent cause of infective endocarditis (IE); associated spondylodiskitis has not yet been described in the literature.
We describe 2 patients who presented with new-onset, severe back pain; blood cultures revealed S. gordonii bacteremia, which led to the diagnosis of spondylodiskitis and IE. We review our 2-decade experience with S. gordonii bacteremia to describe the clinical and epidemiological characteristics of these patients.
In our hospital over the last 20 years (1998-2017), a total of 15 patients with S. gordonii bacteremia were diagnosed, including 11 men and 4 women, and the mean age was 65 ± 22 (range 23-95). The most common diagnosis was IE (9 patients), spondylodiskitis (the presented 2 patients, who in addition were diagnosed with endocarditis), necrotizing fasciitis (1), sternitis (1), septic arthritis (1) and pneumonia (1). The 11 patients with IE were treated with penicillin ± gentamicin, or ceftriaxone for 6 weeks, 5 required valve surgery and 10/11 (91%) attained complete cure. The 2 patients with diskitis required 2-3 months of intravenous antibiotics to achieve complete cure.
Spondylodiskitis was the presenting symptom of 2/11 (18%) patients with S. gordonii endocarditis. Spondylodiskitis should probably be looked for in patients diagnosed with S. gordonii endocarditis and back pain as duration of antibiotic treatment to achieve complete cure may be considerably longer.
缓症链球菌是感染性心内膜炎（IE）的罕见病因；相关的脊柱骨髓炎尚未在文献中描述。
我们描述了 2 例出现新发、严重背痛的患者；血培养显示缓症链球菌菌血症，从而诊断为脊柱骨髓炎和 IE。我们回顾了我们 20 年来治疗缓症链球菌菌血症的经验，以描述这些患者的临床和流行病学特征。
在我们医院过去 20 年（1998-2017 年）中，共诊断出 15 例缓症链球菌菌血症患者，包括 11 名男性和 4 名女性，平均年龄为 65±22（范围 23-95）。最常见的诊断是 IE（9 例）、脊柱骨髓炎（本文报道的 2 例患者同时被诊断为心内膜炎）、坏死性筋膜炎（1 例）、胸骨炎（1 例）、化脓性关节炎（1 例）和肺炎（1 例）。11 例 IE 患者接受青霉素+庆大霉素或头孢曲松治疗 6 周，5 例需要瓣膜手术，10/11（91%）例患者完全治愈。2 例脊柱骨髓炎患者需要 2-3 个月的静脉抗生素治疗才能完全治愈。
脊柱骨髓炎是 11 例缓症链球菌心内膜炎患者中的 2 例（18%）的首发症状。在诊断为缓症链球菌心内膜炎和背痛的患者中，可能应该寻找脊柱骨髓炎，因为实现完全治愈所需的抗生素治疗持续时间可能会明显延长。
