An 82-year-old man is evaluated for a 2-month history of progressive fatigue and midline lower back pain that has increased in severity. He reports no trauma to the area. Medical history is significant for elective coronary artery bypass surgery 3 months ago. While hospitalized, he developed a central line–associated bloodstream infection with Staphylococcus aureus and a catheter-associated urinary tract infection with Proteus mirabilis. Medications are aspirin, metoprolol, and simvastatin. He is allergic to penicillin.
On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 110/72 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. BMI is 26. Cardiopulmonary examination is normal. He has moderate point tenderness over the third lumbar vertebrae. Lower-extremity evaluation reveals normal motor strength and sensation with symmetrical patellar deep tendon reflexes.
Laboratory studies reveal an erythrocyte sedimentation rate of 110 mm/h, leukocyte count of 10,200/µL (10.2 × 109/L), and serum creatinine of 1.2 mg/dL (106.1 µmol/L). A blood culture is positive for Corynebacterium species, but subsequent cultures are negative.
Findings of MRI of the lumbar spine, with contrast, are consistent with osteomyelitis of the L4 and adjacent L5 vertebral bodies, abnormality in the intervening disc space, and no evidence of an epidural collection.
Which of the following is the most appropriate management?