Osteomyelitis: Difference between revisions
| Line 39: | Line 39: | ||
| [[Sickle Cell Disease]] | | [[Sickle Cell Disease]] | ||
| Salmonella, gram-negative bacteria | | Salmonella, gram-negative bacteria | ||
| [[ | | [[Ceftriaxone]] 50mg/kg IV once daily OR [[Cefotaxime]] 50mg/kg IV three times daily, PLUS<br> | ||
*[[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 | | [[DM]] or vascular insufficiency | ||
Revision as of 18:47, 6 April 2015
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 | Ceftriaxone 50mg/kg IV once daily OR Cefotaxime 50mg/kg IV three times daily, PLUS
|
| 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 bite | Pasteurella, Eikenella, HACEK organism | Piperacillin/Tazobactam 3.375gm OR imipenem 500mg |
See Also
Source
Tintinalli