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Spinal Epidural Abscess: a Series of 101 Cases.
Am J Med. 2017 Aug 07;:
Authors: Vakili M, Crum-Cianflone NF
Abstract
BACKGROUND: Spinal epidural abscesses are uncommon but potentially devastating infections that often elude early diagnosis. An increasing incidence has been suggested; however, few contemporary data are available regarding risk factors and epidemiologic trends over time.
METHODS: A retrospective study of spinal epidural abscesses from 2004 to 2014 at a large academic hospital was conducted. Cases were identified using ICD-9 code 324.1, and a review of medical and radiographic records was performed to confirm each case. Data collected included sociodemographics, medical history, suspected route of infection, treatments, and outcome.
RESULTS: The incidence was 5.1 cases for each 10,000 admissions with no significant changes during the study period. The route of infection was identified in 52% of cases, with bacteremia as the most common (26%), followed by recent surgery/procedure (21%) and spinal injection (6%). An identifiable underlying risk factor was present in 84% of cases, most commonly diabetes and intravenous drug use. A causative organism was identified in 84% of cases, most commonly Staphylococcus aureus; methicillin-resistant isolates accounted for 25% of S. aureus cases. All cases received intravenous antibiotic therapy and 73% underwent a drainage procedure. Fifteen percent had an adverse outcome (8% paralysis and 7% death).
CONCLUSIONS: The incidence of spinal epidural abscesses may be increasing with the current study demonstrating a ≥5-fold higher rate compared with historical data. While the outcome in most cases was favorable, spinal epidural abscesses continue to cause substantial morbidity and mortality and should remain a "not to be missed diagnosis."
PMID: 28797646 [PubMed - as supplied by publisher]