237. Evaluating Epidural Abscess Outcomes in a County Hospital with Antibiotic Therapy Alone Compared to Antibiotics and Surgical Intervention

Background Spinal epidural abscess (SEA) remains a rare suppurative infection which bacteria invade the epidural space through contiguous spread or hematogenous dissemination. Diabetes mellitus (DM), IV drug abuse (IVDA), alcohol abuse, degenerative joint disease (DJD) have been shown to confer risk for SEA. Antimicrobial therapy is critical, but literature remains less clear on surgical intervention. Primary aim for study was to evaluated outcomes with SEA when treated with antibiotics alone compared to antibiotics and surgical intervention at our county hospital. Methods A retrospective case series assessed patients 18 years or older at our county hospital with SEA consulted by infectious disease from 7/2009 to 7/2018. Data collected included demographics, social history (IVDA, alcohol abuse, homelessness), and microbiology results. Physician review of records determined if outcomes of SEA demonstrated improvement of symptoms compared to no improvement of symptoms. Results Of 37 patients, 15 patients were treated with antibiotics alone, 22 with antibiotics plus surgical spinal intervention. Of patients treated with antibiotics alone, 12/15 (80%) had improvement of symptoms and 3/15 (20%) had no improvement of symptoms. Those treated with antibiotics plus surgical intervention, 17/22 (77%) had improvement or resolution of symptoms and 5/22 (23%) had no improvement of symptoms. No statistically difference in outcome was observed between the two groups (p=0.835). The majority of cases were positive for Staphylococcus aureus (21/37, 56.7%). Methicillin-sensitive S. aureus (MSSA) comprised (12/21, 57%) and Methicillin-resistant S. aureus (MRSA) comprised (9/21, 43%). Conclusion Our retrospective study demonstrated no differences in outcome observed between patients treated with antibiotics alone compared to those with antibiotics plus surgical spinal intervention. Staphylococcus aureus was the most common organism. Management of patients with SEA currently remains individualized based on clinical condition, comorbidities and clinician judgement given limited literature. Proper sample collection for cultures and immediate intervention, either antibiotics only or antibiotics plus surgical interventions are crucial for better patient outcomes in SEA. Disclosures All Authors: No reported disclosures