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MRSA Epidural Abscess — SCE Infectious Diseases MCQ

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ModerateCNS InfectionMRSA Epidural AbscessSCE Infectious Diseases

A 50-year-old man with a history of IV drug use presents with acute-onset back pain, fever, and bilateral lower limb weakness (MRC grade 3/5). MRI spine shows a 4 cm epidural abscess at T6–T8 with cord compression. Blood cultures grow MRSA. In addition to emergency surgical decompression, what is the recommended antibiotic and duration?

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Correct answer: E — IV Vancomycin (targeting trough 15–20 mg/L) for at least 6 weeks — with transition to oral agents guided by clinical and radiological response

MRSA spinal epidural abscess with neurological compromise is a combined surgical and medical emergency. IV Vancomycin (trough 15–20 mg/L) is first-line for MRSA. Daptomycin 8–10 mg/kg is an alternative (good bone/epidural penetration). Total antibiotic duration is at least 6 weeks. Post-operative imaging (MRI at 4–6 weeks) guides duration. IV-to-oral switch (to agents with good bioavailability: Linezolid, Co-trimoxazole plus Rifampicin) may be considered after adequate IV induction. The IVDU history should prompt a search for other foci (endocarditis screen with TOE).

Reference: BSAC 2015 – Spinal infections; NICE NG157 2024; BSAC 2023 – MRSA