Diferencia entre revisiones de «Vertebral osteomyelitis»
(Text replacement - "vancomycin " to "vancomycin ") |
Sin resumen de edición |
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==Clinical Features== | ==Clinical Features== | ||
*Usually have had prolonged symptoms (pain >3mo) | *Usually have had prolonged symptoms (pain >3mo) | ||
*At risk for recent bacteremia | *At risk for recent [[bacteremia]] | ||
*Fever is a feature - however, often '''afebrile''' | *[[Fever]] is a feature - however, often '''afebrile''' | ||
*Vertebral body tenderness | *Vertebral body tenderness | ||
*Paravertebral muscle spasm | *Paravertebral muscle spasm unresponsive to conservative therapy | ||
*Paravertebral or | *Paravertebral or [[epidural abscess (spinal)|epidural abscess]] may develop | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revisión actual - 17:03 3 oct 2019
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 unresponsive to conservative therapy
- Paravertebral or epidural abscess may develop
Differential Diagnosis
Spinal infection
Evaluation
- 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
Management
- Antibiotics
- Usually requires IV antibiotic x6wk, then PO antibiotic x 4-8wk
- Consult with spine surgeon before starting antibiotics (may interfere with biopsy culture)
- Piperacillin-tazobactam 3.375gm IV + vancomycin 1gm IV
Disposition
- Normally, initially inpatient treatment