Which doctors at RUSH Medical Center treat skull base osteomyelitis?

Skull Base Osteomyelitis Treatment at RUSH Medical Center

Skull base osteomyelitis (SBO) at RUSH Medical Center should be managed by a multidisciplinary team consisting of infectious disease specialists and spine surgeons, as recommended by the Infectious Diseases Society of America (IDSA) guidelines. 1

Specialist Team for SBO at RUSH

The management of skull base osteomyelitis requires specialized care from:

• Infectious Disease Specialists - Essential for antibiotic management and long-term treatment planning
• Spine Surgeons/Neurosurgeons - For surgical intervention when indicated
• Otolaryngologists - Particularly for cases originating from ear infections
• Radiologists - For specialized imaging interpretation

Diagnostic Approach

MRI with gadolinium is the imaging modality of choice for detecting osteomyelitis 2. When MRI cannot be obtained (due to implantable devices, claustrophobia, etc.), alternative options include:

• Combination spine gallium/Tc99 bone scan
• Computed tomography scan
• Positron emission tomography scan 1

Treatment Protocol

The IDSA guidelines recommend:

1. Image-guided aspiration biopsy to establish microbiologic diagnosis when blood cultures are negative 1
2. Deep tissue specimens rather than superficial swabs for accurate diagnosis 2
3. Immediate surgical intervention for patients with neurologic compromise 1
4. Empiric antimicrobial therapy for patients with hemodynamic instability, sepsis, or progressive neurologic symptoms 1

Antibiotic Regimen

For empiric treatment of SBO, the recommended regimen includes:

• Vancomycin plus a third- or fourth-generation cephalosporin to cover staphylococci (including MRSA), streptococci, and gram-negative bacilli 1, 2
• Consider anti-pseudomonal coverage as Pseudomonas aeruginosa is the most common causative organism in SBO 3, 4
• Duration of therapy typically 6-8 weeks minimum, with some cases requiring prolonged treatment up to 10 months 2, 3

Surgical Indications

Surgical intervention is indicated for:

• Progressive neurologic deficits
• Spinal instability
• Persistent/recurrent bloodstream infection
• Worsening pain despite appropriate medical therapy
• Presence of abscesses requiring drainage 1, 2

Monitoring Treatment Response

• Monitor systemic inflammatory markers (ESR and CRP) after approximately 4 weeks of therapy 1
• Follow-up MRI to assess evolutionary changes in paraspinal and epidural soft tissues in patients with poor clinical response 1
• Persistent pain, residual neurologic deficits, or radiographic findings alone do not necessarily signify treatment failure 1

Special Considerations

• Diabetic patients require special consideration as they are susceptible to otomycosis and necrotizing otitis externa 1
• Immunocompromised patients may require more aggressive treatment and closer monitoring 1, 2
• Fungal SBO should be considered in patients who fail to respond to initial therapy, particularly in immunocompromised hosts 4

Common Pitfalls to Avoid

• Delaying surgical intervention in patients with neurologic deficits
• Inadequate duration of antibiotic therapy (less than 6 weeks)
• Using oral β-lactams, which have poor bioavailability for bone infections
• Relying on superficial wound cultures rather than deep tissue specimens 2

SBO is a life-threatening condition that requires prompt diagnosis and aggressive treatment. The multidisciplinary approach available at RUSH Medical Center provides the comprehensive care needed for this complex infection.