Osteomyelitis: Difference between revisions
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==Background== | == Background == | ||
*Infection of the bone by bacteria or fungus | |||
*Etiology | *Infection of the bone by bacteria or fungus | ||
**Contiguous spread (80%) | *Etiology | ||
**Hematogenous spread (20%) | **Contiguous spread (80%) | ||
***More common in peds (long bones) | **Hematogenous spread (20%) | ||
***More common in peds (long bones) | |||
***Less common in adults (spine) | ***Less common in adults (spine) | ||
==Risk Factors== | == Risk Factors == | ||
*Diabetic pts with one or more of the following: | |||
**Skin ulceration | *Diabetic pts with one or more of the following: | ||
**Positive probe-to-bone test | **Skin ulceration >2cm | ||
**ESR | **Positive probe-to-bone test | ||
**ESR >70 (83-92% Sn) | |||
**Abnormal x-ray | **Abnormal x-ray | ||
==Diagnosis== | == Diagnosis == | ||
*Pain at the site | |||
**May also have warmth, swelling, erythema | *Pain at the site | ||
*X-ray | **May also have warmth, swelling, erythema | ||
**May be normal early in the course | *X-ray | ||
**Later will show bone demineralization, periosteal elevation, lytic lesions | **May be normal early in the course | ||
*Blood culture | **Later will show bone demineralization, periosteal elevation, lytic lesions | ||
*Blood culture | |||
*Bone scan | *Bone scan | ||
==Treatment== | == Treatment == | ||
{| width="500" border="1" cellpadding="1" cellspacing="1" | |||
|- | |||
| Risk Factor | |||
| Likely Organism | |||
| Initial Empiric Antibiotic Therapy | |||
|- | |||
| Elderly, hematogenous spread | |||
| MRSA, MSSA, gram neg | |||
| Vanco 1gm + (piperacillin-tazobactam 3.375 grams OR imipenem 500mg) | |||
|- | |||
| Sickle cell disease | |||
| Salmonella, gram-negative bacteria | |||
| Ciprofloxacin 400mg, consider vanco 1gm | |||
|- | |||
| DM or vascular insufficiency | |||
| Polymicrobial: Staph, strep, coliforms, anaerobes | |||
| Vanco 1gm + (piperacillin-tazobactam 3.375 grams OR imipenem 500mg) | |||
|- | |||
| IV drug user | |||
| MRSA, MSSA, pseudomonas | |||
| Vanco 1gm | |||
|- | |||
| Newborn | |||
| MRSA, MSSA, GBS, gram-negative | |||
| Vanco 15mg/kg load, then reduce dose, AND ceftazidime 30mg/kg IV q12 h | |||
|- | |||
| Children | |||
| MRSA, MSSA | |||
| Vanc 10mg/kg q6 h AND ceftazidime 50mg/kg q8hr | |||
|- | |||
| Postoperative (ortho) | |||
| MRSA, MSSA | |||
| Vanco 1gm | |||
|- | |||
| Human bite | |||
| Strep or anaerobes | |||
| Piperacillin-tazobactam 3.375gm OR imipenem 500mg | |||
|- | |||
| Animal bite | |||
| Pasteurella, Eikenella | |||
| Piperacillin-tazobactam 3.375gm OR imipenem 500mg | |||
|} | |||
==Source== | == Source == | ||
Tintinalli | |||
[[Category:Peds]] | [[Category:Peds]] [[Category:Ortho]] | ||
[[Category:Ortho]] | |||
Revision as of 06:20, 27 September 2011
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
Treatment
| Risk Factor | Likely Organism | Initial Empiric Antibiotic Therapy |
| Elderly, hematogenous spread | MRSA, MSSA, gram neg | Vanco 1gm + (piperacillin-tazobactam 3.375 grams OR imipenem 500mg) |
| Sickle cell disease | Salmonella, gram-negative bacteria | Ciprofloxacin 400mg, consider vanco 1gm |
| DM or vascular insufficiency | Polymicrobial: Staph, strep, coliforms, anaerobes | Vanco 1gm + (piperacillin-tazobactam 3.375 grams OR imipenem 500mg) |
| IV drug user | MRSA, MSSA, pseudomonas | Vanco 1gm |
| Newborn | MRSA, MSSA, GBS, gram-negative | Vanco 15mg/kg load, then reduce dose, AND ceftazidime 30mg/kg IV q12 h |
| Children | MRSA, MSSA | Vanc 10mg/kg q6 h AND ceftazidime 50mg/kg q8hr |
| Postoperative (ortho) | MRSA, MSSA | Vanco 1gm |
| Human bite | Strep or anaerobes | Piperacillin-tazobactam 3.375gm OR imipenem 500mg |
| Animal bite | Pasteurella, Eikenella | Piperacillin-tazobactam 3.375gm OR imipenem 500mg |
Source
Tintinalli