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Severe cellulitis with systemic toxicity — SCE Acute Medicine MCQ

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HardSepsis and Infectious EmergenciesSevere cellulitis with systemic toxicitySCE Acute Medicine

A 71-year-old man has methicillin-sensitive Staphylococcus aureus bacteraemia. After 48 hours of intravenous flucloxacillin he remains febrile and reports new severe thoracic back pain. Neurological examination is normal. What is the most appropriate next investigation?

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Correct answer: B — Perform contrast-enhanced MRI of the whole spine

Persistent S. aureus bacteraemia with new focal spinal pain raises concern for vertebral osteomyelitis, discitis or epidural abscess. MRI is the most sensitive urgent investigation and should not wait for neurological deficit. Repeat blood cultures, echocardiographic assessment and a search for other metastatic foci are also required.

Reference: https://www.rightdecisions.scot.nhs.uk/antimicrobial-prescribing-nhs-borders/adult-hospital-guidance/systemic-and-other-infections/bloodstream-infection-due-to-staphylococcus-aureus/