An elderly patient with back pain called to ED for + blood cultures 2 weeks s/p treatment for Klebsiella UTI found to have epidural abscess.
-Initially, there was a high suspicion for endocarditis given the new murmur found on exam – prompting discussion of empiric therapy
-For native valve endocarditis – common pathogens include S. aureus, Streptococci, Occasional gram negative rods and HACEK organisms – treatment of choice is Vancomycin + Ceftriaxone
-For prosthetic valve endocarditis – common pathogens include S. aureus and S. epidermis; treatment of choice is Vancomycin + Rifampin + Gentamicin
An elderly female w/ history of laminectomy and recent spinal anesthesia presents with acute onset fever and midline low back pain, ultimately found to have subtle enhancement on MRI consistent with an early epidural abscess.
*Because of advanced imaging, we are often catching epidural abscesses at an earlier stage than before. If the clinical scenario fits, even these small enhancements should be treated with IV abx to prevent progression to larger epidural abscesses
*Reimaging for epidural abscess is not recommended unless there is concern for treatment failure (uptrending inflammatory markers, new neuro sx, worsening pain/fever)