To the Editor.—
Though hematogenous osteomyelitis in narcotic addicts certainly does have a predilection for the spine, I doubt that Pseudomonas aeruginosa is most frequently the offending organism. While it is true that Kido and colleagues1 found Pseudomonas in the overwhelming majority of their addicts with vertebral infections, Staphylococcus aureus was the offending organism in half the cases reported by Holzman and Bishko.2 In our recently reported series of patients with cervical osteomyelitis, of the five patients who were addicted to heroin, four were found to be infected with S aureus and no organism was recovered from the other one.Since the treatment of S aureus and P aeruginosa is so entirely different, positive identification of the offending organism is essential, whether it be one of these two or any of many others that have sometimes been reported.
Messer HD. Roentgenographic Aspects of Narcotic Addiction. JAMA. 1977;237(1):24. doi:10.1001/jama.1977.03270280026004