Osteomyelitis: Difference between revisions
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== Background == | == Background == | ||
*Infection of the bone by bacteria or fungus | *Infection of the bone by bacteria or fungus | ||
*Etiology | *Etiology | ||
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***Less common in adults (spine) | ***Less common in adults (spine) | ||
== Risk Factors | ===Risk Factors=== | ||
*Diabetic pts with one or more of the following: | *Diabetic pts with one or more of the following: | ||
**Skin ulceration >2cm | **Skin ulceration >2cm | ||
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== Diagnosis == | == Diagnosis == | ||
*Pain at the site | *Pain at the site | ||
**May also have warmth, swelling, erythema | **May also have warmth, swelling, erythema | ||
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*Bone scan | *Bone scan | ||
== | ==Differential Diagnosis== | ||
{{Template:SSTI DDX}} | |||
==Treatment== | |||
{| width="500" border="1" cellpadding="1" cellspacing="1" | {| width="500" border="1" cellpadding="1" cellspacing="1" | ||
|- | |- | ||
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|- | |- | ||
| Elderly, hematogenous spread | | Elderly, hematogenous spread | ||
| MRSA, MSSA, gram neg | | [[MRSA]], [[MSSA]], [[gram neg]] | ||
| | | [[Vancomycin]] 1gm + ([[Piperacillin/Tazobactam]] 3.375 grams OR [[imipenem]] 500mg) | ||
|- | |- | ||
| Sickle | | [[Sickle Cell Disease]] | ||
| Salmonella, gram-negative bacteria | | Salmonella, gram-negative bacteria | ||
| Ciprofloxacin 400mg, consider | | [[Ciprofloxacin]] 400mg, consider [[vancomycin]] 1gm | ||
|- | |- | ||
| DM or vascular insufficiency | | [[DM]] or vascular insufficiency | ||
| Polymicrobial: Staph, strep, coliforms, anaerobes | | Polymicrobial: Staph, strep, coliforms, [[anaerobes]] | ||
| | | [[Vancomycin]] 1gm + ([[Piperacillin/Tazobactam]] 3.375 grams OR [[imipenem]] 500mg) | ||
|- | |- | ||
| IV drug user | | IV drug user | ||
| MRSA, MSSA, pseudomonas | | [[MRSA]], [[MSSA]], pseudomonas | ||
| | | [[Vancomycin]] 1gm | ||
|- | |- | ||
| Newborn | | Newborn | ||
| MRSA, MSSA, GBS, | | [[MRSA]], [[MSSA]], GBS, [[Gram Negative]] | ||
| | | [[Vancomycin]] 15mg/kg load, then reduce dose, AND [[ceftazidime]] 30mg/kg IV q12 h | ||
|- | |- | ||
| Children | | Children | ||
| MRSA, MSSA | | [[MRSA]], [[MSSA]] | ||
| | | [[Vancomycin]] 10mg/kg q6 h AND [[ceftazidime]] 50mg/kg q8hr | ||
|- | |- | ||
| Postoperative (ortho) | | Postoperative (ortho) | ||
| MRSA, MSSA | | [[MRSA]], [[MSSA]] | ||
| | | [[Vancomycin]] 1gm | ||
|- | |- | ||
| Human bite | | Human bite | ||
| Strep or anaerobes | | Strep or anaerobes | ||
| Piperacillin | | [[Piperacillin/Tazobactam]] 3.375gm OR [[imipenem]] 500mg | ||
|- | |- | ||
| Animal bite | | Animal bite | ||
| Pasteurella, Eikenella | | Pasteurella, Eikenella | ||
| Piperacillin | | [[Piperacillin/Tazobactam]] 3.375gm OR [[imipenem]] 500mg | ||
|} | |} | ||
Revision as of 05:28, 6 April 2014
Background
- Infection of the bone by bacteria or fungus
- Etiology
- Contiguous spread (80%)
- Hematogenous spread (20%)
- More common in peds (long bones)
- Less common in adults (spine)
Risk Factors
- Diabetic pts with one or more of the following:
- Skin ulceration >2cm
- Positive probe-to-bone test
- ESR >70 (83-92% Sn)
- Abnormal x-ray
Diagnosis
- Pain at the site
- May also have warmth, swelling, erythema
- X-ray
- May be normal early in the course
- Later will show bone demineralization, periosteal elevation, lytic lesions
- Blood culture
- Bone scan
Differential Diagnosis
Skin and Soft Tissue Infection
- Cellulitis
- Erysipelas
- Lymphangitis
- Folliculitis
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
- Purple glove syndrome
- Tuberculosis (tuberculous inflammation of the skin)
Treatment
| Risk Factor | Likely Organism | Initial Empiric Antibiotic Therapy |
| Elderly, hematogenous spread | MRSA, MSSA, gram neg | Vancomycin 1gm + (Piperacillin/Tazobactam 3.375 grams OR imipenem 500mg) |
| Sickle Cell Disease | Salmonella, gram-negative bacteria | Ciprofloxacin 400mg, consider vancomycin 1gm |
| DM or vascular insufficiency | Polymicrobial: Staph, strep, coliforms, anaerobes | Vancomycin 1gm + (Piperacillin/Tazobactam 3.375 grams OR imipenem 500mg) |
| IV drug user | MRSA, MSSA, pseudomonas | Vancomycin 1gm |
| Newborn | MRSA, MSSA, GBS, Gram Negative | Vancomycin 15mg/kg load, then reduce dose, AND ceftazidime 30mg/kg IV q12 h |
| Children | MRSA, MSSA | Vancomycin 10mg/kg q6 h AND ceftazidime 50mg/kg q8hr |
| Postoperative (ortho) | MRSA, MSSA | Vancomycin 1gm |
| Human bite | Strep or anaerobes | Piperacillin/Tazobactam 3.375gm OR imipenem 500mg |
| Animal bite | Pasteurella, Eikenella | Piperacillin/Tazobactam 3.375gm OR imipenem 500mg |
See Also
Source
Tintinalli