What is your approach to monitoring of inflammatory markers during treatment of native vertebral osteomyelitis?

As long as the patient is clinically stable and CRP is coming down, there is generally no need for follow up imaging. Key reference: Kowalski et al., PMID 16779743.

Also, good to remember that ESR is a very expensive test which basically measures fibrinogen (may cost $500 or more since it has to be r...

Yes, I do check CRP once weekly. Like Dr. @Dr. First Last - I try VERY hard NOT to order any follow-up MRI imaging - I also recommend the Kowalski paper from CID 2006 that Dr. Winslow referenced. Kowalski's definition of "improved CRP" was only that there was a 25% decrease at 4-8 weeks of follow-up...

I have found ESR much more reliable the CRP. For years, I ordered both. I was trying to determine whether CRP added information not provided by the ESR. I found it didn't. The CRP in our experience falls more quickly and in everyone. The ESR has issues, for sure, but if you get a very high ESR, it i...

For those that monitor weekly inflammatory marker(s), can I ask: how does it change your management when patients improve clinically but markers do not fall satisfactorily? Do you get follow-up imaging? Do you extend antibiotics? Both of these maneuvers seem to have the potential for harm in someone...

Standard is to monitor inflammatory markers. IDSA has good guidelines for the management of NVO.

Berbari et al., PMID 26229122

One thing I would emphasize is that you should follow only CRP as an inflammatory marker. ESR provides no additional information. CRP is much more sensitive and specific for ...

I do not follow erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) during treatment. I follow clinically, particularly neurologic signs and symptoms. Inflammatory markers are not actionable, as the surgeons will not operate on a patient who is completely asymptomatic, and I doubt a pa...