At my hospital, IR/Ortho usually avoid sacral bone Bx. Typically ask ACS to obtain deep necrotic tissues Cx or viable tissues Cx post-debridement if possible.

Last 2 yrs, only seen 1 case who had flap coverage by plastics. So most cases got a short course of Abx

Just screws for flap

Not a pocket of pus. Appears to be a layer of pus covering the epidural space

Questionable CSF leak, not a major issue, but playing it safe. No clue on the outcomes of mino use for epidural abscess. No experience with it and unable to find any useful data

Was also considering 10-12 mg/kg, but surgeon said pus was everywhere - though it was all irrigated and debrided.

Only 1 wk into the course, several more weeks to go. Mino is prob not effective for CNS penetration?

97kg, sounds like the dose was equivalent to 15mg/kg of TMP

Na 140 --> 126 (confused) prompted readmission

@davidvanduin.bsky.social

Hello #IDSky community

60 M w/cerebral HW-related epidural abscess s/p HW removed

Pus Cx w/Steno maltophilia (S - Mino, Levo, TMP/SMX).

On TMP/SMX DS 3 tab TID. Had severe hyponat a wk later (likely TMP/SMX)

Reduce TMP/SMX❓
Levo❓
Cefiderocol❓
Ceftaz-avi + aztreo❓
Others❓

Any thoughts?

Cool! A few highly recommended places:
Asiatique The Riverfront
Wat Pho
Wat Arun
Wat Phra Kaew
They are all connected by a longtail boat via Chaophraya River