RF's/pathogenesis
Risk factors for vertebral osteomyelitis
What is IV drug use, infective endocarditis, degenerative spine disease, prior spinal surgery, DM, corticosteroid therapy or other immunocompromised state?
What is Staphylococcus aureus?
Most common presenting symptom
What is back pain?
Held until a microbiologic diagnosis is confirmed
What is antimicrobial therapy?
Mainstay of vertebral osteomyelitis tx
What is antibiotic therapy?
Most common route of spread to the bone
What is hematogenous spread?
Most common pathogen following urinary tract instrumentation
What is E. coli?
Most common site of the spine involved
What is the lumbar spine?
Imaging modality with relatively limited utility in the evaluation of vertebral osteomyelitis
What is CT?
Long term antibiotic therapy may require insertion of either of these IV devices
What is a mid-line catheter or peripherally inserted central catheter (PICC)?
spread from trauma, invasive spinal diagnostic procedures or spinal surgery
What is direct inoculation?
Most common pathogen in HIV patients
What is Mycobacterium avium complex?
Deficits may be found in this part of the physical exam
What is the neuro exam?
Imaging modality of choice
What is MRI?
duration of therapy
What is 6-8 weeks?
spread of infection from tissues adjacent to the spine, such as aorta, esophagus, or bowel
What is contiguous spread?
Most common pathogens in association with IV access, or IV drug use
What is pseudomonas, coagulase negative staph, and candida?
These inflammatory markers are far more useful in the workup of vertebral osteomyelitis and will often serve as markers for tx success
What is ESR and CRP?
Alternative imaging modality when MRI is contraindicated
What is Nuclear medicine, Gallium-67 single-photon emission computed tomography (SPECT)?
appropriate empiric regimen consists of these agents
Vanc, PLUS one of the following: cefotaxime, ceftazidime, ceftriaxone, cefepime, or cipro
Extension of infection can lead to this
What is epidural abscess, subdural abscess, or meningitis?
Most common organism in endemic regions and immunocompromised pts
What is Mycobacterium tuberculosis and brucellosis?
True or False: Leukocyte count may be elevated or normal
What is true?
Best way to isolate microorganism responsible for the infection
What is CT guided biopsy?
What is neurologic compromise, significant vertebral destruction with spine instability, large epidural abscess formation, intractable back pain and failure of medical therapy?