Medscape -Laurie Barclay, MD- July 31, 2015
"Persistent severe back pain may indicate vertebral osteomyelitis, a rare spine infection that must be diagnosed and treated correctly to prevent serious complications, according to a new Infectious Diseases Society of America (IDSA) guideline.
The guideline was published online July 30 in Clinical Infectious Diseases and on the IDSA website.
Specific recommendations include the following:
- Elevated diagnostic markers of inflammation, such as erythrocyte sedimentation rate and C-reactive protein, may suggest vertebral osteomyelitis.
- Plain radiographs of the spine are not sensitive for early diagnosis.
- Patients with elevated erythrocyte sedimentation rate and C-reactive protein should undergo magnetic resonance imaging to distinguish infection from disc herniation or other structural cause of back pain.
- Unless patients are septic or have neurologic compromise, empiric antimicrobial therapy should be withheld until the microbiologic diagnosis is confirmed.
- However, most patients with Staphylococcus aureus bloodstream infection within the preceding 3 months and compatible spine magnetic resonance imaging changes may be treated empirically without disc space aspiration.
- Treatment usually includes intravenous antibiotics for 6 weeks, based on the results of culture and in vitro susceptibility testing.
- Patients whose pain resolves after antibiotic treatment or surgery generally do not require repeat magnetic resonance imaging."
http://www.medscape.com/viewarticle/848897
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Berbaril E et al. Clin Infect Dis. (2015) doi: 10.1093/cid/civ482
First published online: July 29, 2015
"These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention."
http://cid.oxfordjournals.org/content/early/2015/07/22/cid.civ482.full