Vertebral osteomyelitis
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Vertebral osteomyelitis
Microbiology
- Staphylococcus aureus
- 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
- Doxycycline/rifampin
- Duration: 3 months
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.
