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Infectious Disease
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Vertebral Osteomyelitis
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Suspect with fever + back pain + focal spinal tenderness.
Decision
Outcome
Decision
Fever + back pain + focal spinal tenderness. Initial workup?
✓
Blood cultures + ESR/CRP + plain spinal X-rays
✗
Empiric vancomycin without cultures
Decision
Result?
✓
Elevated ESR/CRP but normal X-rays → MRI
✓
X-rays show changes → MRI for extent + organism workup
Decision
MRI confirms vertebral osteomyelitis ± epidural abscess. Next?
✓
CT-guided needle aspiration/biopsy for organism
✗
Empiric antibiotics for 6 weeks without culture
Outcome
Targeted antibiotics 6 weeks based on culture; surgery for abscess, instability, or neuro deficit
Most common organism: Staph aureus. IV drug users may have Pseudomonas.