Vertebral osteomyelitis: Difference between revisions

m (Rossdonaldson1 moved page Vertebral Osteomyelitis to Vertebral osteomyelitis)
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==Background==
==Clinical Features==
==Clinical Features==
*Pts usually have had prolonged symptoms (pain >3mo)
*Usually have had prolonged symptoms (pain >3mo)
*Pts at risk for recent bacteremia
*At risk for recent bacteremia
*Fever is a feature - however, pts are often '''afebrile'''
*Fever is a feature - however, 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
*Paravertebral or epidural abscess may develop
==Differential Diagnosis==
{{Spinal infection types}}


==Diagnosis==
==Diagnosis==
*ESR (almost always elevated)
*ESR (almost always elevated)
*Blood cx
*Blood cultures
*Imaging
*Imaging
**May take 2-8 weeks to see changes
**May take 2-8 weeks to see changes
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==Treatment==
==Treatment==
*Antibiotics
*[[Antibiotics]]
**Usually requires IV abx x6wk, then PO abx x 4-8wk
**Usually requires IV abx x6wk, then PO abx x 4-8wk
**Consult w/ spine surgeon before starting antibiotics (may interfere w/ biopsy culture)
**Consult with spine surgeon before starting antibiotics (may interfere with biopsy culture)
**Piperacillin-tazobactam 3.375gm IV + vanco 1gm IV
**[[Piperacillin-tazobactam]] 3.375gm IV + vanco 1gm IV
 
==Disposition==


==Source==
==References==
*Tintinalli
*Merck Manuals


[[Category:Ortho]]
[[Category:Ortho]]
[[Category:Neuro]]
[[Category:ID]]

Revision as of 23:50, 5 June 2015

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 unreponsive to conservative therapy
  • Paravertebral or epidural abscess may develop

Differential Diagnosis

Spinal infection

Diagnosis

  • 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

Treatment

  • Antibiotics
    • Usually requires IV abx x6wk, then PO abx x 4-8wk
    • Consult with spine surgeon before starting antibiotics (may interfere with biopsy culture)
    • Piperacillin-tazobactam 3.375gm IV + vanco 1gm IV

Disposition

References