Vertebral osteomyelitis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Usually have had prolonged symptoms (pain >3mo) | *Usually have had prolonged symptoms (pain >3mo) | ||
*At risk for recent bacteremia | *At risk for recent [[bacteremia]] | ||
*Fever is a feature - however, often '''afebrile''' | *[[Fever]] is a feature - however, often '''afebrile''' | ||
*Vertebral body tenderness | *Vertebral body tenderness | ||
*Paravertebral muscle spasm | *Paravertebral muscle spasm unresponsive to conservative therapy | ||
*Paravertebral or epidural abscess may develop | *Paravertebral or [[epidural abscess (spinal)|epidural abscess]] may develop | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Spinal infection types}} | {{Spinal infection types}} | ||
== | ==Evaluation== | ||
*ESR (almost always elevated) | *ESR (almost always elevated) | ||
*Blood cultures | *Blood cultures | ||
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**Bony destruction, irregularity of vertebral end places, disk space narrowing | **Bony destruction, irregularity of vertebral end places, disk space narrowing | ||
== | ==Management== | ||
*[[Antibiotics]] | *[[Antibiotics]] | ||
**Usually requires IV | **Usually requires IV antibiotic x6wk, then PO antibiotic x 4-8wk | ||
**Consult with spine surgeon before starting antibiotics (may interfere with biopsy culture) | **Consult with spine surgeon before starting antibiotics (may interfere with biopsy culture) | ||
**[[Piperacillin-tazobactam]] 3.375gm IV + | **[[Piperacillin-tazobactam]] 3.375gm IV + [[vancomycin]] 1gm IV | ||
==Disposition== | ==Disposition== | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Latest revision as of 17:03, 3 October 2019
Background
Clinical Features
- Usually have had prolonged symptoms (pain >3mo)
- At risk for recent bacteremia
- Fever is a feature - however, often afebrile
- Vertebral body tenderness
- Paravertebral muscle spasm unresponsive to conservative therapy
- Paravertebral or epidural abscess may develop
Differential Diagnosis
Spinal infection
Evaluation
- ESR (almost always elevated)
- Blood cultures
- Imaging
- May take 2-8 weeks to see changes
- Bony destruction, irregularity of vertebral end places, disk space narrowing
Management
- Antibiotics
- Usually requires IV antibiotic x6wk, then PO antibiotic x 4-8wk
- Consult with spine surgeon before starting antibiotics (may interfere with biopsy culture)
- Piperacillin-tazobactam 3.375gm IV + vancomycin 1gm IV
Disposition
- Normally, initially inpatient treatment