Spectrum: Local Antimicrobial Stewardship, for UCLA Health

Concern for Discitis/Vertebral Osteomyelitis

Note

If blood culture results positive prior to IR aspiration, proceed directly to step 3.

Procedures

1. Consider CT guided aspiration/biopsy (neuro-radiology)

Consult Peds ID

2. Send specimen in sterile specimen cup:

  • Aerobic cultures

  • Histopathology

  • If < 3 years old, also send in blood culture bottle (Kingella Kingae) and PCR*

*Kingella PCR

Order "Misc. Referral Lab Test "

  • Test code: 18872

  • Accepted Specimen type: 0.7mL synovial fluid in a leak-proof container

  • Performing Lab: Quest

  • Test name: Kingella kingae DNA, Qualitative, real-time PCR

3. Initiate empiric antibiotic.

  • IV Vancomycin unless otherwise specified by ID consultant*

  • Await culture results for specific antibiotic selection

Vancomycin IV

*Additional Gram Negative Coverage

*Consider need for additional gram negative coverage if:

  • < 36 months old

  • Immunocompromised

  • Sickle cell

4. Observe on intravenous antibiotics

  • Consider transfer to pediatric service

  • Start CCS Application and consult social work

5. Monitor clinical and laboratory response. Repeat CRP every 48 hours.

Evaluate Response

Adequate Response to Treatment

  • Clinical exam improved

  • WBC normalized

  • CRP apprpropriately down-trending

Inadequate Response to Treatment