Clinical approach to vertebral osteomyelitis in adults

ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; MRI: magnetic resonance imaging; CT: computed tomography.
* Additional diagnostic testing may be warranted based on epidemiologic factors (eg, to evaluate for infection due to brucellosis or tuberculosis); refer to the UpToDate topic on vertebral osteomyelitis and discitis in adults for discussion.
¶ Refer to the UpToDate topic on vertebral osteomyelitis and discitis in adults for discussion of characteristic radiographic findings, differential diagnosis, and approach to antibiotic selection.
Δ A needle biopsy may not be necessary in patients with clinical and radiographic findings typical of vertebral osteomyelitis and positive blood cultures with a likely pathogen; refer to the UpToDate topic on vertebral osteomyelitis and discitis in adults for further discussion.
◊ Biopsy material should be sent for bacterial (aerobic and anaerobic) culture, fungal culture, and mycobacterial culture in addition to histologic examination.