title: Characteristics and predictors of outcome of spontaneous spinal epidural abscesses treated conservatively: A retrospective cohort study in a referral center.
abstract: OBJECTIVE
  Recent studies have shown that in carefully selected patients, conservative treatment alone can be an option in the management of spinal epidural abscess (SEA). The aim of this study was to identify prognostic factors of outcome in patients with spontaneous SEA treated conservatively.
  
  
  METHODS
  A retrospective cohort study of all patients with spontaneous SEA treated with antibiotics alone from January 2012 to December 2015 was conducted in a 1200-bed tertiary referral center. Demographic, clinical, microbiological, and radiological characteristics were analyzed. Failure of medical treatment was defined as the need for delayed surgical intervention, no neurological improvement or deterioration, death due to the infection, or relapse after hospital discharge.
  
  
  RESULTS
  We identified 21 patients diagnosed with spontaneous SEA treated conservatively. Median age was 72 years and 10 patients were male. Eleven patients presented with radicular weakness and/or radicular sensory deficit, or incomplete cord injury. Inflammatory markers were markedly elevated in all patients. Thirteen patients were successfully treated with conservative treatment, while among 8 patients with treatment failure, 1 died due to the infection. Presence of serious neurological deficits and infection due to methicillin-resistant S. aureus (MRSA) were associated with failure of conservative treatment. Notably, neither the extension nor the location of the abscess on magnetic resonance imaging (MRI) was associated with failed medical management.
  
  
  CONCLUSIONS
  A significant proportion of patients with spontaneous SEA can respond to antibiotic treatment alone. However, in patients with infection due to MRSA or with severe neurological impairment, conservative management has an increased risk of failure.
authors.affiliation: Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Heraklion, Heraklion, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Spernovasilis
authors.affiliation: Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece.
authors.forename: Stelios
authors.initials: S
authors.lastname: Demetriou
authors.affiliation: Department of Internal Medicine, "Venizelion" General Hospital of Heraklion, Heraklion, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Bachlitzanaki
authors.affiliation: Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Heraklion, Heraklion, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Gialamas
authors.affiliation: Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Heraklion, Greece; Faculty of Medicine, University of Crete, Heraklion, Greece.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Alpantaki
authors.affiliation: Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Heraklion, Heraklion, Greece; Faculty of Medicine, University of Crete, Heraklion, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Hamilos
authors.affiliation: Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece; Faculty of Medicine, University of Crete, Heraklion, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Karantanas
authors.affiliation: Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Heraklion, Heraklion, Greece; Faculty of Medicine, University of Crete, Heraklion, Greece. Electronic address: gikas.achilles@uoc.gr.
authors.forename: Achilleas
authors.initials: A
authors.lastname: Gikas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D000072700:Conservative Treatment; D020802:Epidural Abscess / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012678:Sensation Disorders / Q000209:etiology; D013119:Spinal Cord Injuries / Q000209:etiology; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Conservative management; Epidural; Outcome; Spinal epidural abscess; Spinal infection