Risk Factors for Spinal Epidural Abscesses

Building on Dr. Corwell's pearl from last week concerning Spinal Epidural Abscess, risk factors for Spinal Epidural Abscesses other than IV drug abuse are:

1. Diabetes
2. ESRD
3. Septicemia
4. HIV infection
5. Malignancy
6. Morbid obesity
7. Long-term corticosteroid use
8. Alcoholism
9. Infection at a distal site
10. Indwelling catheters
11. Spinal surgery

The infection can occur via three routes 1) hematogenous spread 2) Direct Extension from a local infection such as osteoomyelitis, and 3) iatrogenic introduction which is thought to be responsible for 14-22% of the cases.  A catheter in the epidural space for more than 2 days has a infection rate of 4.3%.

References

Marc Tompkins, Ian Panuncialman, Phillip Lucas, Mark Palumbo.  Spinal Epidural Abscess The Journal of Emergency Medicine, Volume 39, Issue 3, September 2010, Pages 384-390