, Volume 46, Issue 2, pp 245–251 | Cite as

Endocarditis associated with vertebral osteomyelitis and septic arthritis of the axial skeleton

  • Oscar Murillo
  • Imma Grau
  • Joan Gomez-Junyent
  • Celina Cabrera
  • Alba Ribera
  • Fe Tubau
  • Carmen Peña
  • Javier Ariza
  • Roman Pallares
Original Paper



The relationship between infective endocarditis (IE) and osteoarticular infections (OAIs) are not well known. We aimed to study the characteristics of patients with IE and OAIs, and the interactions between these two infections.


An observational study (1993–2014) which includes two cohorts: (1) patients with IE (n = 607) and (2) patients with bacteremic OAIs (n = 458; septic arthritis of peripheral and axial skeleton, and vertebral and peripheral osteomyelitis). These two cohorts were prospectively collected, and we retrospectively reviewed the clinical and microbiological variables.


There were 70 cases of IE with concomitant OAIs, representing 11.5% of IE cases and 15% of bacteremic OAI cases. Among cases with IE, the associated OAIs mainly involved the axial skeleton (n = 54, 77%): 43 were vertebral osteomyelitis (61%), mainly caused by “less virulent” bacteria (viridans and bovis streptococci, enterococci, and coagulase-negative staphylococci), and 15 were septic arthritis of the axial skeleton (21%), which were mainly caused by Staphylococcus aureus. OAIs with involvement of the axial skeleton were associated with IE (adjusted OR = 2.2; 95% CI 1.1–4.3) independently of age, sex, and microorganisms.


Among patients with IE, the associated OAIs mainly involve the axial skeleton. Transesophageal echocardiography should be carefully considered in patients presenting with these bacteremic OAIs.


Endocarditis Osteoarticular infections Bacteremia Septic arthritis Axial skeleton Vertebral osteomyelitis 



We thank Michael Maudsley for helping with the English in this manuscript.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The institutional review board approved this study and publication of the results. The need for informed consent was waived as the study analysed data retrospectively and the data were anonymized.


  1. 1.
    Sapico FL, Liquete JA, Sarma RJ. Bone and joint infections in patients with infective endocarditis: review of a 4-year experience. Clin Infect Dis. 1996;22:783–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Mansur AJ, Grinberg M, da Luz PL, Bellotti G. The complications of infective endocarditis. A reappraisal in the 1980s. Arch Intern Med. 1992;152:2428–32.CrossRefPubMedGoogle Scholar
  3. 3.
    Sapico FL, Montgomerie JZ. Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Rev Infect Dis. 1979;1:754–76.CrossRefPubMedGoogle Scholar
  4. 4.
    Churchill MA, Geraci JE, Hunder GG. Musculoskeletal manifestations of bacterial endocarditis. Ann Intern Med. 1977;87:754–9.CrossRefPubMedGoogle Scholar
  5. 5.
    González-Juanatey C, González-Gay MA, Llorca J, et al. Rheumatic manifestations of infective endocarditis in non-addicts. A 12-year study. Medicine (Baltimore). 2001;80:9–19.CrossRefGoogle Scholar
  6. 6.
    Pigrau C, Almirante B, Flores X, et al. Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome. Am J Med. 2005;118:1287.CrossRefPubMedGoogle Scholar
  7. 7.
    Le Moal G, Roblot F, Paccalin M, et al. Clinical and laboratory characteristics of infective endocarditis when associated with spondylodiscitis. Eur J Clin Microbiol Infect Dis. 2002;21:671–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Sapico FL, Montgomerie JZ. Vertebral osteomyelitis in intravenous drug abusers: report of three cases and review of the literature. Rev Infect Dis. 1980;2:196–206.CrossRefPubMedGoogle Scholar
  9. 9.
    Scheidegger C, Zimmerli W. Infectious complications in drug addicts: seven-year review of 269 hospitalized narcotics abusers in Switzerland. Rev Infect Dis. 1989;11:486–93.CrossRefPubMedGoogle Scholar
  10. 10.
    Murillo O, Roset A, Sobrino B, et al. Streptococcal vertebral osteomyelitis: multiple faces of the same disease. Clin Microbiol Infect. 2014;20:O33–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Mulleman D, Philippe P, Senneville E, et al. Streptococcal and enterococcal spondylodiscitis (vertebral osteomyelitis). High incidence of infective endocarditis in 50 cases. J Rheumatol. 2006;33:91–7.PubMedGoogle Scholar
  12. 12.
    Murillo O, Grau I, Lora-Tamayo J, et al. The changing epidemiology of bacteraemic osteoarticular infections in the early 21st century. Clin Microbiol Infect. 2015;21:254.e1–8.Google Scholar
  13. 13.
    Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Clinical and Laboratory Standards Institute. Methods for dilution antimicrobial susceptibility test for bacteria that grow aerobically. Approved standard, 8th ed, M7-A8 CLSI, Wayne; 2009.Google Scholar
  15. 15.
    Sherman JM. The streptococci. Bacteriol Rev. 1937;1:3–97.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Lew DP, Waldvogel FA. Osteomyelitis. Lancet. 2004;364:369–79.CrossRefPubMedGoogle Scholar
  17. 17.
    Shirtliff ME, Mader JT. Acute septic arthritis. Clin Microbiol Rev. 2002;15:527–44.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Zimmerli W. Clinical practice. Vertebral osteomyelitis. N Engl J Med. 2010;362:1022–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351:1645–54.CrossRefPubMedGoogle Scholar
  20. 20.
    Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015;132:1435–86.CrossRefPubMedGoogle Scholar
  21. 21.
    Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis. Eur Heart J. 2015;36:3075–128.CrossRefPubMedGoogle Scholar
  22. 22.
    Lamas C, Bóia M, Eykyn SJ. Osteoarticular infections complicating infective endocarditis: a study of 30 cases between 1969 and 2002 in a tertiary referral centre. Scand J Infect Dis. 2006;38:433–40.CrossRefPubMedGoogle Scholar
  23. 23.
    Weber M, Gubler J, Fahrer H, et al. Spondylodiscitis caused by viridans streptococci: three cases and a review of the literature. Clin Rheumatol. 1999;18:417–21.CrossRefPubMedGoogle Scholar
  24. 24.
    Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev. 2015;28:603–61.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Watkins RR, David MZ, Salata RA. Current concepts on the virulence mechanisms of meticillin-resistant Staphylococcus aureus. J Med Microbiol. 2012;61:1179–93.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Nolla JM, Lora-Tamayo J, Gómez Vaquero C, et al. Pyogenic arthritis of native joints in non-intravenous drug users: a detailed analysis of 268 cases attended in a tertiary hospital over a 22-year period. Semin Arthritis Rheum. 2015;45:94–102.CrossRefPubMedGoogle Scholar
  27. 27.
    Bossert M, Prati C, Bertolini E, Toussirot E, Wendling D. Septic arthritis of the acromioclavicular joint. Joint Bone Spine. 2010;77:466–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Ross JJ, Hu LT. Septic arthritis of the pubic symphysis: review of 100 cases. Medicine (Baltimore). 2003;82:340–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Ross JJ, Shamsuddin H. Sternoclavicular septic arthritis: review of 180 cases. Medicine (Baltimore). 2004;83:139–48.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Oscar Murillo
    • 1
  • Imma Grau
    • 1
  • Joan Gomez-Junyent
    • 1
  • Celina Cabrera
    • 1
  • Alba Ribera
    • 1
  • Fe Tubau
    • 2
    • 3
  • Carmen Peña
    • 1
  • Javier Ariza
    • 1
  • Roman Pallares
    • 1
  1. 1.Infectious Diseases Department, IDIBELL-Hospital Universitari de BellvitgeUniversity of BarcelonaBarcelonaSpain
  2. 2.Microbiology DepartmentIDIBELL-Hospital Universitari de BellvitgeBarcelonaSpain
  3. 3.Spain Ciber de Enfermedades Respiratorias ISCIIIMadridSpain

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