Figure 2. Management
Antimicrobials
Stable
Sepsis, shock,
severe or
proegressive
neurologic Sx
Neurologic
compromise
Established
pathogen
Hold antibiotics
until pathogen
identified
Empiric
antimicrobials
Immediate
surgery and
empiric
antimicrobials
IV or highly
available oral Rx
for 6 weeks
Surgery
Progressive neurologic deficits,
progressive deformity and
spinal instability
Persistent or recurrent
bloodstream infection or
worsening pain despite Rx
Surgery
Debridement
Follow-up
Suspected
treatment
failure
Spine surgeon and
infectious disease
physician
Clinical assessment, ESR and
CRP ~4 weeks aer Rx
MRI only if responding poorly
Image-guided aspiration
biopsy or surgical sampling
for histopatholog y and
microbiolog y
POS
POS
MRI
ESR & CRP
OR