Spinal epidural abscess

For spontaneous cases of spinal epidural abscess (SEA), there is no specific prevention strategy, although the incidence in specific at-risk patient groups may be reduced. For example, all patients with Staphylococcus aureus bacteraemia (even when related to a removable focus) should receive an adequate course of antibiotics. Risk may be reduced in patients with diabetes mellitus by optimal glycaemic control, and in patients who use intravenous drugs by appropriate counselling.

For cases associated with spinal surgery or neuraxial catheterisation, certain practices may reduce the risk of SEA. These include careful preoperative skin preparation (e.g., hair removal with electric clippers immediately preoperatively, and extensive skin cleansing/topical antibiotics).​[26]Seal LA, Paul-Cheadle D. A systems approach to preoperative surgical patient skin preparation. Am J Infect Control. 2004 Apr;32(2):57-62. http://www.ncbi.nlm.nih.gov/pubmed/15057196?tool=bestpractice.com [27]Mallik J, Motiani V, Pai MG. Spinal epidural abscess post spinal anesthesia: an uncommon complication of a common procedure. Asian J Neurosurg. 2020 Aug 28;15(3):730-2. https://www.thieme-connect.de/products/ejournals/html/10.4103/ajns.AJNS_154_20 http://www.ncbi.nlm.nih.gov/pubmed/33145241?tool=bestpractice.com ​​

Recurrence of SEA is rare, but risk is higher in patients with a history of intravenous drug use, bowel dysfunction at presentation, or concurrent local spinal wound infection.[63]Shah AA, Yang H, Ogink PT, et al. Independent predictors of spinal epidural abscess recurrence. Spine J. 2018 Oct;18(10):1837-44. http://www.ncbi.nlm.nih.gov/pubmed/29649612?tool=bestpractice.com

Continued treatment or prevention of predisposing causes of SEA in appropriate patients is important. These include optimal glycaemic control in patients with diabetes mellitus, treatment of immunosuppression, and counselling for cessation of intravenous drug use.