Vertebral osteomyelitis is a disc and vertebral infection that causes nonspecific symptoms such as back pain, fever, and weakness. The most common causative pathogen is Staphylococcus aureus, and Escherichia coli (E. coli) is an uncommon cause. An 88-year-old man presented to the emergency department with a fever and lower back pain. His blood cultures were persistently positive for E. coli on days one, three, and five, and a diagnosis of vertebral osteomyelitis was made after an MRI of the lumbar spine. It has been reported that infectious dissemination to the vertebrae may occur through Batson's venous plexus, which is a network of paravertebral veins, and the pelvic venous plexus. Clinicians should remember that vertebral osteomyelitis can be a cause of persistent bacteremia.