Number of epidural abscesses increases
By Laura Madden-Fuentes
Infections in the space around the spinal cord have increased over the past decade, and many are associated with antibiotic-resistant bacteria.
Rabih Darouiche, M.D., professor of physical medicine and rehabilitation and medicine at Baylor College of Medicine in Houston, noted that increasingly, these infections, called epidural abscesses, are caused by methicillin-resistant Staphylococcus aureus, or MRSA. That means they are resistant to treatment with commonly used antibiotics.
The increased use of spinal procedures in pain management has contributed to the escalation in the rates of these infections, said Darouiche, who practices at the Michael E. DeBakey Veterans Affairs Medical Center.
Initial misdiagnoses
"However, what was most significant and alarming was the fact that the majority of cases continue to be misdiagnosed upon initial presentation," he said.
Many times, especially in those patients in the early stages of infection who are thinking clearly, more common infections like meningitis, urinary tract infections or sepsis may be diagnosed instead. Sometimes, noninfectious ailments such as a spinal tumor, a prolapsed disc or even joint disease will be diagnosed. Symptoms of the disorder include back pain, fever and indications of nerve problems.
Misdiagnosis wastes precious time because the infection can progress rapidly without treatment and ultimately result in paralysis or even death, said Darouiche.
Imaging is crucial
Only imaging studies, such as MRIs or CT scans combined with myelography, an X-ray examination of the central nervous structures of the spinal column, can effectively confirm a diagnosis of spinal epidural abscess.
Surgical drainage of the space around the spine along with antibiotics is the standard treatment. It should be undertaken at once to prevent possible paralysis, said Darouiche.
He discussed the issue in depth in a recent issue of the New England Journal of Medicine. (N Engl J Med 2006; 355:2012-2020, Nov 9, 2006)
