Vertebral osteomyelitis: Difference between revisions

Latest revision as of 23:17, 12 March 2022

Background

Microbiology

Staphylococcus aureus
Other Gram-positive cocci, including viridans group streptococci, Streptococcus bovis, enterococci, Streptococcus agalactiae, group C and G streptococci
Less commonly, coagulase-negative staphylococci, Gram-negative bacilli, including Pseudomonas aeruginosa, and Candida, especially in patients with indwelling lines or injection drug use
Tuberculosis
Brucella, in patients from endemic countries, can be as high as 25% of cases

Management

IV or highly bioavailable oral (metronidazole, fluoroquinolones, linezolid, TMP-SMX, clindamycin, and doxycycline/rifampin)
- Can double-cover Enterococcus with an aminoglycoside for 4 to 6 weeks
Duration: 6 weeks for most, but 3 months for Brucella

Brucella

Combination of doxycycline and rifampin
Duration: 3 months

With Orthopedic Hardware

Often treated with retention of hardware, especially in early-onset disease1
Early onset (<4 to 6 weeks post-op)
- I&D with retention of hardware and bone graft material, with primary closure instead of a drain, if feasible
Late onset (more than 4 to 6 weeks post-op)
- Fusion achieved: incision and drainage with removal of hardware
- Fusion not achieved: retention of hardware with suppressive antibiotics until fusion is achieved, then removal of hardware

Prognosis

Cure rates are 70-90% with 6 weeks of antibiotics, and are not higher with longer durations (per a single RCT)
Poor prognosis is associated with multidisc disease, the presence of concomitant epidural abscess, lack of surgical therapy, infection with S. aureus, old age, or the presence of significant comorbidities

References

^ Kivanc Atesok, Alexander Vaccaro, Martina Stippler, Brendan M. Striano, Michael Carr, Michael Heffernan, Steven Theiss, Efstathios Papavassiliou. Fate of Hardware in Spinal Infections. Surgical Infections. 2020;21(5):404-410. doi:10.1089/sur.2019.206.

@@ Line 1: / Line 1: @@
+==Background==
-= Microbiology =
+===Microbiology===
-* ''Staphylococcus aureus''
-* ''Brucella'', in patients from endemic countries, can be as high as 25% of cases
+*[[Staphylococcus aureus]]
-= Management =
+*Other [[Gram-positive cocci]], including [[viridans group streptococci]], [[Streptococcus bovis]], [[enterococci]], [[Streptococcus agalactiae]], group C and G [[streptococci]]
+*Less commonly, [[coagulase-negative staphylococci]], [[Gram-negative bacilli]], including [[Pseudomonas aeruginosa]], and [[Candida]], especially in patients with indwelling lines or injection drug use
+*[[Tuberculosis]]
+*[[Brucella melitensis|Brucella]], in patients from endemic countries, can be as high as 25% of cases
+==Management==
-* IV or highly bioavailable oral (metronidazole, fluoroquinolones, linezolid, TMP-SMX, clindamycin, and doxycycline/rifampin)
-** Can double-cover ''Enterococcus'' with an aminoglycoside for 4 to 6 weeks
-* Duration: 6 weeks for most, but 3 months for ''Brucella''
-*
+*IV or highly bioavailable oral ([[metronidazole]], [[fluoroquinolones]], [[linezolid]], [[TMP-SMX]], [[clindamycin]], and [[doxycycline]]/[[rifampin]])
-== ''Brucella'' ==
+**Can double-cover ''[[Enterococcus]]'' with an [[Aminoglycosides|aminoglycoside]] for 4 to 6 weeks
+*Duration: 6 weeks for most, but 3 months for ''[[Brucella]]''
+===''Brucella''===
-* Doxycycline/rifampin
-* Duration: 3 months
+*Combination of [[doxycycline]] and [[rifampin]]
-= Prognosis =
+*Duration: 3 months
+=== With Orthopedic Hardware ===
-* Cure rates are 70-90% with 6 weeks of antibiotics, and are ''not'' higher with longer durations (per a single RCT)
-* Poor prognosis is associated with multidisc disease, the presence of concomitant epidural abscess, lack of surgical therapy, infection with ''S. aureus'', old age, or the presence of significant comorbidities
+* Often treated with retention of hardware, especially in early-onset disease[[CiteRef::atesok2020fa]]
+* Early onset (<4 to 6 weeks post-op)
+** I&D with retention of hardware and bone graft material, with primary closure instead of a drain, if feasible
+* Late onset (more than 4 to 6 weeks post-op)
+** Fusion achieved: incision and drainage with removal of hardware
+** Fusion not achieved: retention of hardware with suppressive antibiotics until fusion is achieved, then removal of hardware
+==Prognosis==
+*Cure rates are 70-90% with 6 weeks of antibiotics, and are ''not'' higher with longer durations (per a single RCT)
+*Poor prognosis is associated with multidisc disease, the presence of concomitant epidural abscess, lack of surgical therapy, infection with ''S. aureus'', old age, or the presence of significant comorbidities
 [[Category:Bone and joint infections]]