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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
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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
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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
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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
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For further reading...
Posted 11/23/16 10:57:35 AM by Matthew Cummings
Created by Christopher Kelly
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.