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July/August 2015
PATIENT CARE AND SCIENCE
Guideline on Diagnosis and Management of Vertebral Osteomyelitits Released
A new guideline released by IDSA on vertebral osteomyelitis warns that patients with persistent back pain despite therapy may have a spine infection that could lead to paralysis or death if not diagnosed and treated correctly. The first US guideline on this infection, it has been published in the journal of Clinical Infectious Diseases.  

Vertebral osteomyelitis is fairly rare, and therefore often is overlooked because it causes back pain, a common ailment usually triggered by a pulled muscle or spine injury. Every year, two to six out of 100,000 people get vertebral osteomyelitis, in which bacteria enter into the blood stream and lodge in a disc, the structure that acts as a shock absorber between vertebrae in the spine. While vertebral osteomyelitis can occur in anyone, the infection is most common in older patients.

Simple blood tests to check for inflammation (including sedimentation rate and C-reactive protein) can help determine if vertebral osteomyelitis may be causing the pain, the guidelines note. If those tests are positive, the guidelines recommend the patient have a magnetic resonance imaging (MRI) test, which can differentiate between an infection and a common back problem, such as a slipped disc. If vertebral osteomyelitis is suspected after the MRI, the patient should have a biopsy to confirm infection and determine the bacteria responsible. Treatment typically involves six weeks of intravenous (IV) antibiotics. In about half of patients, surgery to remove the infection may be necessary.

Elie F. Berbari, MD, FIDSA, associate chair of education for the division of infectious disease at Mayo Clinic College of Medicine, and Steven K. Schmitt, MD, FIDSA, infectious disease physician at Cleveland Clinic co- authored the guidelines with the support an 11-member panel including infectious diseases physicians, an orthopedic surgeon and a radiologist. In addition to Drs. Berbari and Schmitt, the panel included: Souha S. Kanj, MD, FACP, FIDSA; Todd J. Kowalski, MD; Rabih O. Darouiche, MD; Andreas Widmer, MS, MD;  Edward Hendershot, MD; Paul Holtom, MD; Paul Huddleston III, MD; Gregory Petermann, MD; and Douglas Osmon, MD.

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