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Staphylococci are the most frequent cause of vertebral osteomyelitis, but infections due to unusual pathogens are also reported. We describe a rare case of spondylodiscitis due to Lactobacillus paracasei . A 74-year-old diabetic male was evaluated for fever and back pain. Blood cultures and vertebral biopsy were positive for Lactobacillus paracasei . He often took laxatives and probiotics for chronic constipation. After target treatment the patient improved but he died for a heart attack two months after the end of the treatment. Although Lactobacillus paracasei is usually not pathogenic, sepsis is described in immunocompromised patients while vertebral osteomyelitis is rare., Competing Interests: Conflicts of interest The authors declare that they have no conflicts of interest regarding the publication of this paper.

Chronic bacterial osteomyelitis requires long-term antibiotic treatment (at least 6-8 weeks). After in-hospital management, patients are usually discharged and treated in outpatient settings. However, when the aetiology is represented by Gram-negative microorganisms, outpatient treatment could be difficult. Beta-lactam administration by means of an elastomeric infusor may represent an attractive approach. We report two cases of osteomyelitis due to Pseudomonas aeruginosa successfully treated with continuous ceftazidime administration via an elastomeric infusor in outpatient settings. In both cases the patients were free from clinical and laboratory signs of osteomyelitis at the end of treatment and after 12 months follow-up.