Chronic abx for chronic uti- lumbar rfa?

[PMROralBoards]

I have a little old lady who has benefited from RFAs in the past from a different clinic. New patient to my clinic but she is on chronic antibiotics for chronic UTIs. She is just always symptomatic apparently with dysuria. No systemic symptoms.

I can’t find guidelines that address this other than listing “infection” as a contraindication. Is there anything I’m missing or any consensus statement to back me up in court if I do the procedure that I think will actually help the patient? Would a clear risk/benefit consent discussion be enough?

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[Snowmen96]

To the best of my knowledge, the contra-indication is a local infection affecting the tissues adjacent to the site of injection. If some bacteria were to be present in her bloodstream, they'll be thoroughly cooked by the RFA, therefore making it unlikely that there would be a spinal infection.

 

[clubdeac]

I think you’re fine but not bc of the explanation above. I’ve seen women on chronic prophylactic antibiotics due to recurrent UTIs. In this situation no problem. If acute actual UTI I wouldn’t bc of possible bacteremia and seeding of the procedure site

 

[oneforfighting]

Done plenty of injections with patients on chronic suppressive antibiotics. Just nothing active or active symptoms.

 

[Taus]

Done plenty of injections with patients on chronic suppressive antibiotics. Just nothing active or active symptoms.

To stir the pot a little bit…

How long after discitis would you wait to do an ESI? Let’s say patient has had clear MRI w contrast and labs several months after infection, on suppressive antibiotics, long-term per ID.

 

[oneforfighting]

To stir the pot a little bit…

How long after discitis would you wait to do an ESI? Let’s say patient has had clear MRI w contrast and labs several months after infection, on suppressive antibiotics, long-term per ID.

TBH never had this scenario. But here’s what I’d do. I’d get ID’s clearance to spread the liability and if patient okay with shared decision making, proceed with injection. But at least 3 months if you’re looking at a time frame.

 

[Snowmen96]

"There are relatively few contraindications for radiofrequency ablation. Absolute contraindications include patient refusal, increased intracranial pressure, and local infection."

"Relative contraindications include bacteremia and aberrant congenital or surgical anatomy."

Radiofrequency Ablation - StatPearls - NCBI Bookshelf

 

[lobelsteve]

To stir the pot a little bit…

How long after discitis would you wait to do an ESI? Let’s say patient has had clear MRI w contrast and labs several months after infection, on suppressive antibiotics, long-term per ID.

Never is the only correct answer.

 

[oneforfighting]

Never is the only correct answer.

Why’s that

 

[lobelsteve]

Why’s that

Because epidurals do not cure cancer and I can’t think of any indication where the benefits outweigh the risks.

 

[bedrock]

Because epidurals do not cure cancer and I can’t think of any indication where the benefits outweigh the risks.

Agree with this. I’d never offer an epidural to a patient who had discitis. RFA fine, but not ESI.

If the discitis patient really wants an ESI, I’d suggest they consult the closest university/medical school hospital.

 

[oneforfighting]

Agree with this. I’d never offer an epidural to a patient who had discitis. RFA fine, but not ESI.

If the discitis patient really wants an ESI, I’d suggest they consult the closest university/medical school hospital.

Why is this? Any literature to support increased risks? The premise was that the patient had negative imaging/labs/symptoms, on suppressive antibiotics and ID cleared for injection. Are you saying this patient can never get another LESI in his life?

 

[bedrock]

Why is this? Any literature to support increased risks? The premise was that the patient had negative imaging/labs/symptoms, on suppressive antibiotics and ID cleared for injection. Are you saying this patient can never get another LESI in his life?

because we live in america with malpractice/personal injury lawyers enabled and encouraged by the democratic lobby.

Same reason I will do absolutely nothing for a pregnant woman in America.

If I practiced in a VA or other situation with real protection from frivolous lawsuits I would consider ESI after 3 months of clean labs, no symptoms.

In today America, I send such cases to a tertiary care center.

 

[oneforfighting]

because we live in america with malpractice/personal injury lawyers enabled and encouraged by the democratic lobby.

Same reason I will do absolutely nothing for a pregnant woman in America.

If I practiced in a VA or other situation with real protection from frivolous lawsuits I would consider ESI after 3 months of clean labs, no symptoms.

In today America, I send such cases to a tertiary care center.

I see. Fair enough. I practice in a state that’s more physician friendly so I feel more enabled to take on some more risk.

 

[lobelsteve]

Let ID inject them. Not worth the $80 or <2 wrvu.

 

[Ducttape]

concern on disciitis is risk of recurrent infection at that site.

i would never but have colleagues that would consider. and like lobel mentioned - epidural would be short term treatment without sufficient benefits over risk.



to OP - no contraindication to RFA unless patient has active symptoms of bacteremia. would still document a 1 sentence blurb about "shared-decision making".

 

[MitchLevi]

I've done plenty of injections on patients with a history of discitis.

 

[lobelsteve]

I've done plenty of injections on patients with a history of discitis.

On suppressive Abx for same?

 

[MitchLevi]

On suppressive Abx for same?

No, not on chronic ABx. I should have been more specific.

 

[clubdeac]

I've done plenty of injections on patients with a history of discitis.

You see lot of previous discitis patients? I see just a couple a year

 

[MitchLevi]

You see lot of previous discitis patients? I see just a couple a year

I can’t say I see a lot, but I’ve seen a good number of them, and some of these are ppl I inherit and manage.