Discitis: Difference between revisions
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==Background== | ==Background== | ||
* | *An infection in the intervertebral disc space but also occurs post surgically in approximately 1-2 percent of patients after spinal surgery. | ||
*Infection of nucleus pulposus due to infection of vertebral body end-plate cartilage | *Infection of nucleus pulposus due to infection of vertebral body end-plate cartilage | ||
*Risk Factors: peds (age < 8yo), post-op, immunocompromised | *Risk Factors: peds (age < 8yo), post-op, immunocompromised | ||
Revision as of 01:00, 7 April 2015
Background
- An infection in the intervertebral disc space but also occurs post surgically in approximately 1-2 percent of patients after spinal surgery.
- Infection of nucleus pulposus due to infection of vertebral body end-plate cartilage
- Risk Factors: peds (age < 8yo), post-op, immunocompromised
Clinical Features
- >90% p/w unremitting back or neck pain which awakens them at night
- Fever (60-70%)
- Neuro deficits (10-50%)
- ESR elevation (>90%)
- Leukocytosis (<50%)
Differential Diagnosis
Diagnosis
- Labs
- ESR elevated
- Imaging
- Plain films are rarely positive
- MRI is gold standard
Treatment
IV Antibiotics
- Treatment targets S. aureus, Streptococcus, Pseudomonas, E. coli
Inpatient Therapy
- Vancomycin 15-20 mg/kg IV BID PLUS any of the following:
- Ceftriaxone 2g IV daily
- Cefepime 2g IV IV three times daily
- Ceftazidime 2g IV three times daily
- Ciprofloxacin 400mg IV three times daily
Use cefepime or ciprofloxacin if targeting Pseudomonas spp
Disposition
- Admit to spine service
Source
- Rosen's
- Tintinalli