Osteomyelitis: Difference between revisions

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==Background==
==Background==
*usu hematogenous spread starting @ metaphysis b/c wbc cannot exit there, minor trauma= osteo in rabbits post staph inj(x)
*Infection of the bone by [[bacteria]] or [[fungus]]
*age >2, immunecompetent Rx for staph strep, only need bone if <2 b/c other causes ie e. coli
*Etiology
**Contiguous spread (80%)
**Hematogenous spread (20%)
***More common in pediatric (long bones)  
***Less common in adults (spine)


==Diagnosis==
===Risk Factors===
*usu rubor, dolor etc at about 3-5 days, no xr changes until 10 days
*[[DM|Diabetic]] patients with one or more of the following:
**Skin ulceration >2cm
**Positive probe-to-bone test
**ESR >70 (83-92% Sn)
**Abnormal x-ray


*Bcx alone= org 50% of time, w/ bone & bcx get 70% of org!
==Clinical Features==
*Pain at the site
**May also have warmth, swelling, erythema


*Order xr, cbc, crp, bcx,
==Differential Diagnosis==
{{Template:SSTI DDX}}


==Treatment==
==Evaluation==
ancef or ox
*X-ray
**May be normal early in the course
**Later will show bone demineralization, periosteal elevation, lytic lesions
**Changes 10-21 days after infection
**Sn 43-75%, Sp 75-83%<ref>Pineda et al. Semin Plast Surg 2009;23:80–89.</ref>
*Blood culture
*CT
**Sn 67%, Sp 50%<ref>Pineda et al. Infect Dis Clin N Am. 2006, 20: 789–825</ref>
*[[Mri|MRI]] is the standard for diagnosis (as early as 3-5 days after infection)<ref>Pineda C et al. Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy. Semin Plast Surg. 2009 May; 23(2): 80–89.</ref>
*Bone scan is sensitive, but lacks specificity vs. MRI


[[Category:Peds]]
==Management==
[[Category:Ortho]]
{{Osteomyelitis Antibiotics}}
 
==See Also==
*[[Vertebral Osteomyelitis]]
 
==References==
<references/>
 
[[Category:Pediatrics]]
[[Category:Orthopedics]]
[[Category:ID]]

Latest revision as of 19:25, 6 October 2019

Background

  • Infection of the bone by bacteria or fungus
  • Etiology
    • Contiguous spread (80%)
    • Hematogenous spread (20%)
      • More common in pediatric (long bones)
      • Less common in adults (spine)

Risk Factors

  • Diabetic patients with one or more of the following:
    • Skin ulceration >2cm
    • Positive probe-to-bone test
    • ESR >70 (83-92% Sn)
    • Abnormal x-ray

Clinical Features

  • Pain at the site
    • May also have warmth, swelling, erythema

Differential Diagnosis

Skin and Soft Tissue Infection

Look-A-Likes

Evaluation

  • X-ray
    • May be normal early in the course
    • Later will show bone demineralization, periosteal elevation, lytic lesions
    • Changes 10-21 days after infection
    • Sn 43-75%, Sp 75-83%[1]
  • Blood culture
  • CT
    • Sn 67%, Sp 50%[2]
  • MRI is the standard for diagnosis (as early as 3-5 days after infection)[3]
  • Bone scan is sensitive, but lacks specificity vs. MRI

Management

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 Ceftriaxone 50mg/kg IV once daily OR Cefotaxime 50mg/kg IV three times daily, PLUS
  • Vancomycin 15mg/kg IV four times daily OR
  • Clindamycin 10mg/kg IV PO four times daily OR
  • Nafcillin 50 mg/kg IV four times daily to cover K. Kingae (common in daycare population)
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, anaerobes, HACEK organism Piperacillin/Tazobactam 3.375gm OR imipenem 500mg
Animal bites Pasteurella, Eikenella, HACEK organism Piperacillin/Tazobactam 3.375gm OR imipenem 500mg
Foot puncture wound Pseudomonas Anti-pseudomonal, staph coverage

See Also

References

  1. ↑ Pineda et al. Semin Plast Surg 2009;23:80–89.
  2. ↑ Pineda et al. Infect Dis Clin N Am. 2006, 20: 789–825
  3. ↑ Pineda C et al. Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy. Semin Plast Surg. 2009 May; 23(2): 80–89.
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