Vertebral osteomyelitis

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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