SPINE - NON TRAUMA + TRAUMA
EPIDURAL ABSCESS
Back pain, fever, neurologic deficit
PromptCauses of spinal epidural abscess
ResponseSource of infection often unknown
Direct inoculation
Direct inoculation
- Penetrating injury
- Epidural injection/catheter
- Spinal stimulators
- Vertebral OM
- Retropharyngeal abscess
- Overlying skin ifection/pressure sore
- Psoas abscess
- Skin/soft tissue infection
- IDC
- IE
- Pneumonia
- UTI
PromptRisk factors for epidural abscess
ResponseIVDU
Immunosuppression (diabetes, EtOH, HIV)
Overlying infection from pressure sores
Recent instrumentation/spinal surgery/LP/Spinal anasthetic
Immunosuppression (diabetes, EtOH, HIV)
Overlying infection from pressure sores
Recent instrumentation/spinal surgery/LP/Spinal anasthetic
PromptOrganisms causing spinal epidural abscess
ResponseS. Aureus (+/- MRSA) - 50-65%
Coag negative staph
B-haemolytic strep
Enterococci
Gram negatives eg: E. Coli - 18%
E. Coli
Klebsiella
Pseudomonas - IVDU
% added from orthobullets
Coag negative staph
B-haemolytic strep
Enterococci
Gram negatives eg: E. Coli - 18%
E. Coli
Klebsiella
Pseudomonas - IVDU
% added from orthobullets
PromptExamination in Epidural abscess
ResponseVital signs for systemic complications (Septicaemia)
Assess for spinal cord compression - motor + sensory
Assess for cauda equnia syndrome - Motor + sensory + Perianal tone/sensation
Signs of focal compliacating collections - Secondary abscess sites/splenic/paraspinal abscess
Assess for spinal cord compression - motor + sensory
Assess for cauda equnia syndrome - Motor + sensory + Perianal tone/sensation
Signs of focal compliacating collections - Secondary abscess sites/splenic/paraspinal abscess
PromptInvestigations
ResponseCRP more sensitive than WCC in early disease evolution (FBC probably too non specific)
Blood culture identify causative organism - Guides directed therapy
MRI - confirmed site and extent, confirms co-existant OM, identifies multilevel disease
Consider investigations to identify source - eg: Echo if suspected IE
CT and XR bit of a waste of time
Blood culture identify causative organism - Guides directed therapy
MRI - confirmed site and extent, confirms co-existant OM, identifies multilevel disease
Consider investigations to identify source - eg: Echo if suspected IE
CT and XR bit of a waste of time
PromptAntibiotics for epidural abscess
ResponseFlucloxacillin 2g QID PLUS Ceftriaxone 2g BD +/- Vancomycin
Ceftriaxone 2g BD PLUS vancomycin (Mild penicillin allergy)
Ciprofloxacin 400 mg TDS IV PLUS Vancomycin (Severe penicillin allergy)
Cefepime 2g TDS + Vancomycin (Post spinal surgery/hardware infection)
eTG may ‘24
Ceftriaxone 2g BD PLUS vancomycin (Mild penicillin allergy)
Ciprofloxacin 400 mg TDS IV PLUS Vancomycin (Severe penicillin allergy)
Cefepime 2g TDS + Vancomycin (Post spinal surgery/hardware infection)
eTG may ‘24