Vertebral osteomyelitis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Pts usually have had prolonged symptoms (pain >3mo) | *Pts usually have had prolonged symptoms (pain >3mo) | ||
*Fever | *Pts at risk for recent bacteremia | ||
*Fever is a feature -however, pts are often '''afebrile''' | |||
*Vertebral body tenderness | *Vertebral body tenderness | ||
*Paravertebral muscle spasm unreponsive to conservative therapy | *Paravertebral muscle spasm unreponsive to conservative therapy | ||
*Paravertebral or epidural abscess may develop | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 13:08, 19 September 2014
Clinical Features
- Pts usually have had prolonged symptoms (pain >3mo)
- Pts at risk for recent bacteremia
- Fever is a feature -however, pts are often afebrile
- Vertebral body tenderness
- Paravertebral muscle spasm unreponsive to conservative therapy
- Paravertebral or epidural abscess may develop
Diagnosis
- ESR (almost always elevated)
- Blood cx
- Imaging
- May take 2-8 weeks to see changes
- Bony destruction, irregularity of vertebral end places, disk space narrowing
Treatment
- Antibiotics
- Usually requires IV abx x6wk, then PO abx x 4-8wk
- Consult w/ spine surgeon before starting antibiotics (may interfere w/ biopsy culture)
- Piperacillin-tazobactam 3.375gm IV + vanco 1gm IV
Source
- Tintinalli