Vertebral osteomyelitis: Difference between revisions
No edit summary |
|||
Line 2: | Line 2: | ||
*Pts usually have had prolonged symptoms (pain >3mo) | *Pts usually have had prolonged symptoms (pain >3mo) | ||
*Pts at risk for recent bacteremia | *Pts at risk for recent bacteremia | ||
*Fever is a feature -however, pts are often '''afebrile''' | *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 |
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