Native Vertebral Osteomyelitis in Adults
Key Points
Key Points
NVO is commonly monomicrobial and most frequently due to Staphylococcus aureus.
The diagnosis of NVO is often delayed and often initially managed as degenerative spine disease.
NVO is typically diagnosed in the setting of recalcitrant back pain unresponsive to conservative measures and elevated systemic inflammatory markers with or without fever.
The majority of patients are cured with a 6 week course of antimicrobial therapy, but some patients may need surgical debridement and/or spinal stabilization during or after a course of antimicrobial therapy.
Diagnosis
Diagnosis
fever, (S/L)...
...ated ESR or CRP, (S/L)675...
...ncomitant bloodstream infection or infec...
...new neurologic symptoms with or without ba...
...d neck or back pain, following a rec...
...ends performing a pertinent medical...
IDSA recommends obtaining bacterial (aero...
IDSA recommends a spine MRI in patients with...
...ests a combination spine gallium/Tc99 bone...
...obtaining blood cultures and serology tests...
...ggests obtaining fungal blood cultures in patient...
...ggests performing a purified protein derivative (P...
...h suspected NVO, evaluation by an infe...
...commends an image-guided aspiration b...
...vises against performing an image-guide...
...ises against performing an image-guided aspirati...
...ients with neurologic compromise with o...
...s the addition of fungal, mycobacterial...
...the addition of fungal and mycobacterial cu...
...adequate tissue can be safely obtained,...
...the absence of concomitant bloodstream inf...
...ents with a non-diagnostic first im...
...ients with suspected NVO and a non-diagnostic imag...
Treatment
...atment
...ibiotics...
...tients with normal and stable neurol...
...ents with hemodynamic instability, sepsis, sep...
...mmends a total duration of 6 weeks of parenteral o...
...commends a total duration of 3 mont...
Surger...
...recommends surgical intervention in patien...
...A suggests surgical debridement with or withou...
...against surgical debridement and/or stabi...
Follow-Up
Follow-U...
...temic Inflammatory Markers and MR...
...nitoring systemic inflammatory markers (...
...ends against routinely ordering follow-up...
IDSA suggests performing a follow-up MR...
...ure of Therap...
IDSA suggests that persistent pain, resi...
...th NVO and suspected treatment failure, I...
...nds obtaining a follow-up MRI with emph...
...with NVO and clinical and radiographi...
...tients with NVO and clinical and radiog...
...1. Evaluation...
...e 2. Management...
...enteral Antimicrobial Treatment of C...
...ble 2. Selected Oral Antibacterial...