02-28-2008, 05:29 PM
A 35-year-old woman with a history of injection drug use is hospitalized because of a 5-day history of fever and increasing back pain that has not responded to continued use of pain medications. On the day of admission, she noted some weakness and numbness of her left leg.
On physical examination, her temperature is 38.2 °C (100.8 °F), pulse rate is 88/min, respiration rate is 14/min, and blood pressure is 110/68 mm Hg. There is tenderness to palpation of the lumbar spine at the level of L3“L4. Neurologic examination is significant for 3/5 motor strength and diminished pain sensation in the left lower extremity.
MRI of the lumbar spine shows evidence of osteomyelitis at L3“L4 with involvement of the disc space and an epidural collection that is hyperintense on T2-weighted images. The patient is sent to the operating room for laminectomy with drainage of the epidural collection.
Which of the following empiric antimicrobial regimens should be initiated following drainage of the collection?
A Vancomycin
B Vancomycin plus cefepime
C Isoniazid, rifampin, pyrazinamide, and ethambutol
D Amphotericin B lipid complex
On physical examination, her temperature is 38.2 °C (100.8 °F), pulse rate is 88/min, respiration rate is 14/min, and blood pressure is 110/68 mm Hg. There is tenderness to palpation of the lumbar spine at the level of L3“L4. Neurologic examination is significant for 3/5 motor strength and diminished pain sensation in the left lower extremity.
MRI of the lumbar spine shows evidence of osteomyelitis at L3“L4 with involvement of the disc space and an epidural collection that is hyperintense on T2-weighted images. The patient is sent to the operating room for laminectomy with drainage of the epidural collection.
Which of the following empiric antimicrobial regimens should be initiated following drainage of the collection?
A Vancomycin
B Vancomycin plus cefepime
C Isoniazid, rifampin, pyrazinamide, and ethambutol
D Amphotericin B lipid complex