Vertebral osteomyelitis: Difference between revisions
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==Background== | |||
==Clinical Features== | ==Clinical Features== | ||
* | *Usually have had prolonged symptoms (pain >3mo) | ||
* | *At risk for recent bacteremia | ||
*Fever is a feature - however, | *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 | *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 | **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== | |||
== | ==References== | ||
[[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