Epidural abscess

- Infectious complication of:

  • endocarditis
  • vertebral osteomyelitis
  • psoas muscle abscess.

Diagnosis:

- Classic triad of symptoms:

  • back pain
  • fever
  • neurologic deficit.

Management:

- MRI

- Surgical drainage often necessary if:

  • lesions > 3cm
  • gas present in abscess
  • no improvement with medical therapy.

- Treat according to C&S results of blood cultures or CT-guided aspirate of abscess.

 
Usual Pathogens

S. aureus/MRSA
Enterobacterales
Streptococci
CoNS
P. aeruginosa
Anaerobes

 

Empiric Therapy Dose Duration
Vancomycin 60mg/kg/d IV div q6h 6 weeks
+    
Ceftriaxone 100mg/kg/d IV div q12h  
+    
Metronidazole 30mg/kg/d IV div q8h