Spinal epidural abscess in adults caused by Staphylococcus aureus: Clinical characteristics and prognostic factors

Huang, Po‐Yu; Chen, Shufeng; Chang, Wen-Neng; Lu, Chen-Hsien; Chuang, Yao-Chung; Tsai, Nai‐Wen; Chang, Chiung‐Chih; Wang, Hung-Chen; Chien, Chun-Chih; Chen, Shang-Hang; Huang, Chaoran

doi:10.1016/j.clineuro.2011.12.006

Cited by 60 publications

(53 citation statements)

References 23 publications

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“…17,21 Such suspicion, along with early neuroimaging studies, is crucial for diagnosis and management. 17 Certain predisposing conditions can further increase clinical suspicion.…”

Section: Discussionmentioning

confidence: 99%

“…17,21 Such suspicion, along with early neuroimaging studies, is crucial for diagnosis and management. 17 Certain predisposing conditions can further increase clinical suspicion. The literature cites the most common predisposing factor as being diabetes mellitus, along with previous spinal intervention, intravenous drug abuse, alcoholism, renal failure, bacteremia, and chronic inflammatory conditions.…”

Section: Discussionmentioning

confidence: 99%

“…46 Frequently reported concurrent conditions are diabetes mellitus, previous spine surgery, intravenous drug abuse, epidural anesthesia, alcoholism, renal failure, hemodialysis, systemic chronic disorders, and immunosuppression. 3,17,21,33,43 Factors that can be associated with a worse prognosis are older age, diabetes mellitus, neurological and mental deterioration, and dorsal location of the SEA. 1,8,9,19,23,32 Additionally, higher reoperation and mortality rates are associated with renal failure and hemodialysis.…”

Section: Literature Reviewmentioning

confidence: 99%

“…4,38 Therapy should be culture specific, and peripheral blood cultures can be possibly used as indicators of the pathogen. 10,17,32 Computed to- mography-guided percutaneous aspiration can be both diagnostic and therapeutic. 9 In previous years, surgical intervention was the mainstay of management of this infection process, particularly when symptoms had not been present for longer than 36-72 hours.…”

Section: 3341mentioning

confidence: 99%

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An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

Shweikeh

Saeed

Bukavina

et al. 2014

FOC

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Object Over the past decade, the incidence of bacterial spinal epidural abscess (SEA) has been increasing. In recent years, studies on this condition have been rampant in the literature. The authors present an 11-year institutional experience with SEA patients. Additionally, through an analysis of the contemporary literature, they provide an update on the challenging and controversial nature of this increasingly encountered condition. Methods An electronic medical record database was used to retrospectively analyze patients admitted with SEA from January 2001 through February 2012. Presenting symptoms, concurrent conditions, microorganisms, diagnostic modalities, treatments, and outcomes were examined. For the literature search, PubMed was used as the search engine. Studies published from January 1, 2000, through December 31, 2013, were critically reviewed. Data from articles on methodology, demographics, treatments, and outcomes were recorded. Results A total of 106 patients with bacterial SEA were identified. The mean ± SD age of patients was 63.3 ± 13.7 years, and 65.1% of patients were male. Common presenting signs and symptoms were back pain (47.1%) and focal neurological deficits (47.1%). Over 75% of SEAs were in the thoracolumbar spine, and over 50% were ventral. Approximately 34% had an infectious origin. Concurrent conditions included diabetes mellitus (35.8%), vascular conditions (31.3%), and renal insufficiency/dialysis (30.2%). The most commonly isolated organism was Staphylococcus aureus (70.7%), followed by Streptococcus spp. (6.6%). Surgery along with antibiotics was the treatment for 63 (59.4%) patients. Surgery involved spinal fusion for 19 (30.2%), discectomy for 14 (22.2%), and corpectomy for 9 (14.3%). Outcomes were reported objectively; at a mean ± SD follow-up time of 8.4 ± 26 weeks (range 0–192 weeks), outcome was good for 60.7% of patients and poor for 39.3%. The literature search yielded 40 articles, and the authors discuss the result of these studies. Conclusions Bacterial SEA is an ominous condition that calls for early recognition. Neurological status at the time of presentation is a key factor in decision making and patient outcome. In recent years, surgical treatment has been advocated for patients with neurological deficits and failed response to medical therapy. Surgery should be performed immediately and before 36–72 hours from onset of neurological sequelae. However, the decision between medical or surgical intervention entails individual patient considerations including age, concurrent conditions, and objective findings. An evidence-based algorithm for diagnosis and treatment is suggested.

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“…17,21 Such suspicion, along with early neuroimaging studies, is crucial for diagnosis and management. 17 Certain predisposing conditions can further increase clinical suspicion.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Section: 3341mentioning

confidence: 99%

See 2 more Smart Citations

An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

Shweikeh

Saeed

Bukavina

et al. 2014

FOC

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“…Because the most common causative organism of spinal intradural abscess is Staphylococcus aureus and there is a high incidence of methicillin-resistance, Huang et al 5 recommended the use of vancomycin as an initial empirical antibiotic in treatment of acute bacterial spinal abscess. In the presented case we used the combination of vancomycin and metronidazole to ensure a wide-spectrum antimicrobial treatment, because the patient had rapidly progressive neurologic deficits.…”

Section: Discussionmentioning

confidence: 99%

Spinal intradural abscess caused by hematogenous spread of Prevotella oralis in a 3-year-old child with an asymptomatic congenital spinal abnormality

Karatay¹,

Köktekir

Çelik³

et al. 2015

Spinal Cord

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Method: We report a 3-year-old child with progressive paraparesis who was diagnosed with an intradural spinal abscess, epidermoid cyst and dermal sinus. The patient was treated surgically followed by antimicrobial treatment. Result: Intraoperative abscess culture was positive for Prevotella oralis, which has not been reported before as a single isolate in literature. The patient's neurologic status was significantly improved after surgical treatment. Conclusion: Prophylactic antimicrobial therapies should cover the anaerobic bacteria in spinal intradural abscess. Surgical decompression with laminectomy and duraplasty may be warranted to achieve immediate neurologic improvement in such cases.

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Central Nervous System Infections

Archibald

Quisling

2013

Textbook of Neurointensive Care

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Spinal epidural abscess in adults caused by Staphylococcus aureus: Clinical characteristics and prognostic factors

Cited by 60 publications

References 23 publications

An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

Spinal intradural abscess caused by hematogenous spread of Prevotella oralis in a 3-year-old child with an asymptomatic congenital spinal abnormality

Central Nervous System Infections

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