Spinal epidural abscess: Difference between revisions

Latest revision as of 03:03, 10 December 2021

Background

Infection of the epidural space, between the dura mater and bone, in the spine
Acquired from contiguous spread (e.g. discitis, otitis media/sinusitis/mastoiditis, direct inoculation (e.g. spinal anaesthesia or neurosurgery), or hematogenous spread
Risk factors include intravenous drug use, hemodialysis, diabetes mellitus, and older age

Microbiology

Staphylococcus aureus is most common cause (63%)
Gram-negative bacilli (16%)
Streptococci (9%)
Coagulase-negative staphylococci (3%), mostly in patients with hardware
Anaerobes (2%)
Fungal or parasitic (1%)
Unknown (6%)
Tuberculosis, in endemic countries

Etiologies

Idiopathic (30%)
Skin and soft tissue infection (22%)
Spinal surgery or procedure (12%)
Injection drug use (10%)
Other sources including epidural catheters (8%)
Bone and joint infections (7%), including decubitus ulcers
Urinary tract (3%)
Upper respiratory tract (3%)
Sepsis (2%)
Abdomen (2%)
Intravascular catheter (<1%)

Risk Factors

Diabetes mellitus (present in 50%)
Injection drug use
Spinal surgery or procedure

Clinical Manifestations

Severe low-back pain often worse with palpation
Fever
Malaise
Neurologic deficits associated with mass effect on spinal cord, interruption of arterial supply, venous thrombosis, or toxin

Staging of Spinal Epidural Abscess

Stage 1: back pain at the level of the affected spine
Stage 2: nerve-root pain radiating from the involved spinal area
Stage 3: motor weakness, sensory deficit, and bladder and bowel dysfunction
Stage 4: paralysis

Diagnosis

Usually made by MRI (or CT with contrast)
Blood cultures may be helpful
Cultures from the abscess fluid, if possible

Management

May need urgent neurosurgical drainage if neurological symptoms
Intravenous antibiotics, ideally after blood cultures are drawn
Typical empiric antibiotics are ceftriaxone and vancomycin
Duration typically 6 to 8 weeks after source control
Patients treated non-operatively may need to have antibiotics continued to radiographic resolution of the abscess

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
-* Infection of the epidural space, between the dura mater and bone
+*Infection of the epidural space, between the dura mater and bone, in the spine
+*Acquired from contiguous spread (e.g. discitis, otitis media/sinusitis/mastoiditis, direct inoculation (e.g. spinal anaesthesia or neurosurgery), or hematogenous spread
-* May be intracranial or spinal, with spinal being far more common
+*Risk factors include intravenous drug use, [[hemodialysis]], [[diabetes mellitus]], and older age
-* Acquired from contiguous spread (e.g. discitis, otitis media/sinusitis/mastoiditis, direct inoculation (e.g. spinal anaesthesia or neurosurgery), or hematogenous spread
-* Risk factors include intravenous drug use, [[hemodialysis]], [[diabetes mellitus]], and older age
-=== Microbiology ===
+===Microbiology===
-* [[Staphylococcus aureus]] is most common cause
+*[[Staphylococcus aureus]] is most common cause (63%)
+*[[Gram-negative bacilli]] (16%)
+*[[Streptococci]] (9%)
+*[[Coagulase-negative staphylococci]] (3%), mostly in patients with hardware
+*[[Anaerobes]] (2%)
+*Fungal or parasitic (1%)
+*Unknown (6%)
+*[[Tuberculosis]], in endemic countries
+=== Etiologies ===
-== Clinical Manifestations ==
+* Idiopathic (30%)
-* Severe low-back pain often worse with palpation
+* Skin and soft tissue infection (22%)
-* Fever
+* Spinal surgery or procedure (12%)
-* Malaise
+* Injection drug use (10%)
-* Neurologic deficits associated with mass effect on spinal cord, interruption of arterial supply, venous thrombosis, or toxin
+* Other sources including epidural catheters (8%)
+* Bone and joint infections (7%), including decubitus ulcers
+* Urinary tract (3%)
+* Upper respiratory tract (3%)
+* Sepsis (2%)
+* Abdomen (2%)
+* Intravascular catheter (<1%)
-== Diagnosis ==
+=== Risk Factors ===
+* [[Diabetes mellitus]] (present in 50%)
-* Usually made by MRI (or CT with contrast)
+* Injection drug use
-* Blood cultures may be helpful
+* Spinal surgery or procedure
-* Cultures from the abscess fluid, if possible
+==Clinical Manifestations==
-== Management ==
+*Severe low-back pain often worse with palpation
-* May need urgent neurosurgical drainage if neurological symptoms
+*Fever
-* Intravenous antibiotics, ideally after blood cultures are drawn
+*Malaise
-* Typical empiric antibiotics are [[Is treated by::ceftriaxone]] and [[Is treated by::vancomycin]]
+*Neurologic deficits associated with mass effect on spinal cord, interruption of arterial supply, venous thrombosis, or toxin
+===Staging of Spinal Epidural Abscess===
+*Stage 1: back pain at the level of the affected spine
+*Stage 2: nerve-root pain radiating from the involved spinal area
+*Stage 3: motor weakness, sensory deficit, and bladder and bowel dysfunction
+*Stage 4: paralysis
+==Diagnosis==
+*Usually made by MRI (or CT with contrast)
+*Blood cultures may be helpful
+*Cultures from the abscess fluid, if possible
+==Management==
+*May need urgent neurosurgical drainage if neurological symptoms
+*Intravenous antibiotics, ideally after blood cultures are drawn
+*Typical empiric antibiotics are [[Is treated by::ceftriaxone]] and [[Is treated by::vancomycin]]
+*Duration typically 6 to 8 weeks after source control
+*Patients treated non-operatively may need to have antibiotics continued to radiographic resolution of the abscess
-[[Category:Infectious diseases]]
-[[Category:Bone and joint infections]]
 [[Category:CNS infections]]