What can be used to treat infection after a spinal injection?

From the Guidelines

If you suspect an infection after a spinal injection, seek immediate medical attention as this is a serious condition requiring professional treatment. Infections following spinal procedures typically require intravenous antibiotics such as vancomycin, ceftriaxone, or meropenem, administered in a hospital setting for several weeks 1. These infections cannot be adequately treated with over-the-counter medications or oral antibiotics alone. Warning signs of infection include fever, increasing back pain, headache, neck stiffness, or drainage from the injection site. Spinal infections can lead to meningitis or epidural abscesses, which may cause permanent neurological damage if not promptly treated.

The treatment approach depends on the specific bacteria causing the infection, which requires proper cultures and testing by healthcare professionals 1. In some cases, surgical drainage may be necessary alongside antibiotic therapy. Do not attempt to self-diagnose or self-treat a suspected spinal infection, as delayed proper treatment can lead to serious complications. Key considerations in managing such infections include:

• Identifying the causative organism through microbiologic examination of tissue samples 1
• Consulting with a spine surgeon and an infectious disease physician for comprehensive care 1
• Administering appropriate antimicrobial therapy based on culture and susceptibility testing results 1

Given the potential for severe morbidity and mortality associated with spinal infections, it is crucial to prioritize prompt and effective treatment, ideally under the guidance of specialists in infectious diseases and spinal surgery 1.

From the FDA Drug Label

Vancomycin Hydrochloride for Injection, USP is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (β-lactam-resistant) staphylococci Vancomycin Hydrochloride for Injection, USP is effective in the treatment of staphylococcal endocarditis Its effectiveness has been documented in other infections due to staphylococci, including septicemia, bone infections, lower respiratory tract infections, skin and skin structure infections.

Vancomycin can be used to treat infection after spinal injection if it is caused by susceptible strains of methicillin-resistant staphylococci or other vancomycin-susceptible organisms 2.

• The drug is effective against staphylococcal infections, including septicemia, bone infections, and skin and skin structure infections.
• However, culture and susceptibility information should be considered when selecting or modifying antibacterial therapy.

From the Research

Treatment of Infection after Spinal Injection

• Infection after spinal injection or surgery can be treated with antibiotics, with the duration of treatment varying depending on the type of infection and the patient's condition 3.
• The use of intrawound vancomycin powder in addition to intravenous administration of antibiotics has been shown to reduce the risk of deep infection after spinal surgeries 4, 5.
• The ideal duration of antibiotics for preventing infections such as epidural abscess, vertebral osteomyelitis, and discitis after spinal injection or surgery is still controversial, with some studies supporting standard prophylactic antimicrobial treatment for 48 hours and others demonstrating that extended therapy for one week or greater is necessary 3.
• MRI is currently the most sensitive and specific technique to diagnose postoperative spinal infections, and CT guided aspiration culture should be performed in all patients with deep-seated infections with negative blood cultures 6.
• The onset of the infection differentiates the specific treatment, with early infections requiring different treatment approaches than late infections 6.

Prevention of Infection after Spinal Injection

• Lumbar spinal steroid injections (LSSI) within 30 days of lumbar spine surgery may be associated with a higher risk of postoperative infection, particularly for lumbar spine fusion surgery 7.
• The use of prophylactic antibiotics and intrawound vancomycin powder may help reduce the risk of infection after spinal injection or surgery 4, 5.
• Careful clinical interpretation of the results is necessary when considering the risk of infection after spinal injection or surgery, given the absence of high-level studies in the literature 7.