Epidural Abscess

Epidural Abscess is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • A rare pyogenic infection of the spinal epidural space:
    • 2–25/100,000 admissions
  • Most common in thoracic spine, followed by lumbar and cervical

Etiology

  • Focus of infection is present followed by either hematogenous spread (∼50%) or direct extension:
    • No focus identified in ∼1/3
  • Most common source is skin infection:
    • Any pyogenic infection may be source
  • Staphylococcus aureus accounts for >50% of cases:
    • Many are MRSA
    • Streptococcus is second most common
  • Haemophilus influenzae, gram-negative bacilli, mycobacteria, anaerobic, coagulase-negative Staphylococcus, fungal, and mixed infections also occur
  • Complication of epidural catheter or spinal surgery
  • Unusual complication of lumbar puncture (usually follows multiple attempts)

Pediatric Considerations
  • Children present similar to adults with back pain, fever, and neurologic signs as well as nonspecific systemic symptoms
  • Infants may exhibit only fever, irritability, and associated meningitis
  • Sphincter disturbance is frequently seen
  • Usually secondary to hematogenous spread
  • Location and bacteriology similar to adults

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Basics

Description

  • A rare pyogenic infection of the spinal epidural space:
    • 2–25/100,000 admissions
  • Most common in thoracic spine, followed by lumbar and cervical

Etiology

  • Focus of infection is present followed by either hematogenous spread (∼50%) or direct extension:
    • No focus identified in ∼1/3
  • Most common source is skin infection:
    • Any pyogenic infection may be source
  • Staphylococcus aureus accounts for >50% of cases:
    • Many are MRSA
    • Streptococcus is second most common
  • Haemophilus influenzae, gram-negative bacilli, mycobacteria, anaerobic, coagulase-negative Staphylococcus, fungal, and mixed infections also occur
  • Complication of epidural catheter or spinal surgery
  • Unusual complication of lumbar puncture (usually follows multiple attempts)

Pediatric Considerations
  • Children present similar to adults with back pain, fever, and neurologic signs as well as nonspecific systemic symptoms
  • Infants may exhibit only fever, irritability, and associated meningitis
  • Sphincter disturbance is frequently seen
  • Usually secondary to hematogenous spread
  • Location and bacteriology similar to adults

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