Today we talked about a woman with a paraspinal abscess and Staphylococcus Aureus in the blood.
Some pearls of the discussion were:
- Causes of paraspinal/epidural abscess include: IVDU, endocarditis, contiguous spread from GI/GU infections
- Psoriasis is a risk factor for SA bacteremia. These patients should also have their psoriasis treated (note psoriatic skin lesions do not count as a removable source of infection)
- Psoas abscess is often a clue that there is a vertebral infection (as the infection spreads into the psoas from the vertebral/paravertebral space). Thus, if patient has a psoas abscess, consider getting a spine MRI as well.
- Staph Aureus bacteremia should be treated with 4-6 weeks of IV antibiotics unless all of the following conditions are met in which case can treat for 2 weeks (based on this 2003 Archives paper):
1. removable source
2. no evidence of metastatic infection
3. Resolution of fever by 72 hours of therapy
4. Negative blood cultures by 48-96 hours
For more on Staph Aureus bacteremia see this previous blogpost
For more on epidural abscess, see this previous blogpost as well as this NEJM paper
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