Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Order spine CT with contrast and initiate broad spectrum antibiotics
2%
29/1811
MRI of the spine with contrast and obtain image guided aspiration biopsy/culture
32%
578/1811
Take the patient for urgent surgical debridement with intraoperative cultures
1%
23/1811
MRI of the spine with contrast and collection of blood cultures
58%
1045/1811
Collect blood cultures and initiate broad spectrum antibiotics
7%
123/1811
Select Answer to see Preferred Response
When there is suspicion of a spine infection in a hemodynamically normal patient without neurologic compromise the collection of bacterial (aerobic and anaerobic) blood cultures (2 sets) to establish a microbiologic diagnosis is recommended prior to initiated antimicrobial therapy. Spinal infections are caused by direct inoculation, contiguous spread or by hematogenous spread. Pyogenic vertebral osteomyelitis risk factors include recent systemic infections, IV drug use, diabetes, immunodeficiency, malnutrition malignancy, trauma, and smoking. Of those diagnosed with pyogenic vertebral osteomyelitis an associated epidural abscess is present ~18% of the time. Spinal infections can have an insidious onset with relatively benign physical examinations. Identification of the offending infectious agent should be identified prior to the start of antimicrobial therapy. This should be first attempted with blood cultures. When a microbiological diagnosis cannot be confirmed with blood cultures alone then the recommendation is to perform an image-guided aspiration biopsy/culture (or open surgical biopsy) if the patient has a normal and stable neurological examination and stable hemodynamics. Surgical indications include progressive neurologic deficits, worsening deformity, and spinal deformity despite appropriate antimicrobial therapy. Berbari et al. published the 2015 Infectious Disease Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. These guidelines have been applied to the pediatric population as well. An emphasis is placed on identifying the microbiologic diagnosis prior to initiating antimicrobial therapy except in septic patients and/or patients with neurologic compromise. Cornett et al. published a review on the evaluation and management of bacterial spine infections in adults. They review the associated risk factors, physical examination findings, diagnostic workup, and treatment options. They recommend identification of the causative organism prior to initiated antimicrobial therapy in the non-septic patient without neurologic compromise. The initial workup should include CBC, CRP, ESR, and 2 sets of blood cultures. If the blood cultures are negative and there has not been any change in the patient's condition then an image guided biopsy should be performed, if possible. Incorrect Answers: Answer 1: MRI of the spine with gadolinium is the modality of choice when there is suspicion of spinal infection. Answer 2: Blood cultures may only be positive 30% of the time; however, they are the least invasive and should be attempted prior to any other more invasive means Answer 3: The patient is hemodynamically normal and does not have any findings concerning for neurologic compromise Answer 5: Antimicrobial therapy should be initiated after a microbiologic diagnosis is made to help direct therapy if the patient remains stable.
1.6
(21)
Please Login to add comment