• Epidural abscess
  • Infection typically occurs hematogenously (bacteremia from other sources/indwelling catheter/IVDU) OR by direct extension from infected vertebra (osteomyelitis) or disk (diskitis), alternatively following spinal surgery or epidural anesthesia
  • Most commonly S. aureus (>60%) >>> GNR > Strep (but think sequelae of vertebral TB if risk factors)
  • Classic indications for surgery: increasing neurologic deficit, persistent severe pain, or persistent fever and leukocytosis despite abx
    • Early surgical consult is essential component of mgmt
  
  

  Posted 11/23/16 10:44:45 AM by Matthew Cummings

• Clindamycin and D-test
  • S. aureus --> some strains (typically MSSA) possess inducible resistance gene --> alters the common ribosomal binding site for macrolides, clindamycin rendering them resistant when exposed, even though sensitivities may report macrolides/clindamycin as being sensitive
    • Positive D-test indicates that there IS THE POSSIBILITY of this resistance emerging and thus clindamycin should be avoided, especially for severe infections
  
  

  Posted 11/23/16 10:49:12 AM by Matthew Cummings

• Multiple GNR infections (esp. separated in time and anatomic location)? Think Strongyloides (GNR translocation in gut)
  
  

  Posted 11/23/16 10:50:01 AM by Matthew Cummings

• Chryseobacterium indologenes
  •  Gram-negative filamentous, rod, found in soil, plants, foodstuffs and water sources including (vents/HD circuits in hospitals)
    • Emerging cause of highly-resistant hospital-acquired infections (VAPs)
      • Mortality for bacteremia ~60%
      • Emergence likely related to increasing use of tigecycline and colistins for other resistant GNRs
    • Often resistant to carbapenems/colistin/polyB, sensitive to TMP-SMX/quinolones
  
  

  Posted 11/23/16 10:55:29 AM by Matthew Cummings

• For further reading...

  Spinal epidural abscess clinical review (NEJM)
  D-test for clindamycin and macrolide resistance
  Clinical and epidemiological features of Chryseobacterium indologenes infections
  
  

  Posted 11/23/16 10:57:35 AM by Matthew Cummings

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