Monitoring
The duration of antibiotic therapy varies between 4-16 weeks, depending on several factors, including comorbidities, rapidity of response to therapy based on clinical and laboratory studies, and the presence or absence of concurrent vertebral osteomyelitis.[2] Throughout this course, the patient should be monitored at least every 2 weeks for evidence of refractory infection.
Laboratory surveillance should include periodic monitoring of white blood cell (WBC) count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) to help evaluate response to treatment.
Rising WBC count, CRP, or ESR suggests treatment failure. In these patients, enhanced magnetic resonance imaging of the whole spine should be repeated. If imaging shows progressive or new enhancing bone/epidural abnormalities, repeat cultures should be taken and alternative antibiotic agents considered based on microbial susceptibility.
If no suspect lesion is identified, other systemic sources of infection should be sought. An echocardiogram should be considered in appropriate settings (e.g., Staphylococcus aureus bacteraemia) to help exclude infective endocarditis.
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