50: Bad to the Bone

This podcast episode addresses the complexities of diagnosing and treating vertebral osteomyelitis, particularly in patients with complicating factors. The discussion covers differentiating typical and atypical presentations of the condition, emphasizing that fever isn't always present. Risk factors such as diabetes, CKD, recent COVID hospitalization, and exposure to TB or Brucella are considered in shaping the differential diagnosis. The speakers highlight the importance of blood cultures and bone biopsies for accurate diagnosis, while also noting the limitations of inflammatory markers. The conversation further explores managing treatment failures, the role of surgical intervention, and the challenge of hardware-related infections, stressing shared decision-making with patients regarding antibiotic duration versus potential surgery.