Term
what is the most common way osteomyelitis is acquired?
second?
third? |
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Definition
1. contiguous spread (47%)
2. Peripheral vascular disease
3. hematogenous |
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Term
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Definition
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Term
| how is osteomyelitis classified? |
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Definition
| by how it reached the bone |
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Term
| What sites are normally involved in contiguous spread? |
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Definition
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Term
| What are the risk factors for contiguous spread? |
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Definition
| hip fractures and open fractures |
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Term
| What sites are generally affected in ages <1? |
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Definition
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Term
| What are the risk factors for heamtogenous spread in <1 yo? |
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Definition
| prematurity, umbilical catheter, perinatal asphysxia |
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Term
What sites are normally affected by hematogenous spread in ages 1-20?
What are their risk factors? |
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Definition
long bones (femur, tibia, humerous)
infection, sickle cell disease, puncture wounds |
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Term
What sites are involved in hematogenous spread in > 50 yo?
What are their risk factors? |
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Definition
vertebrae
DM, blunt trauma, UTI |
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Term
Describe the symptoms of osteomyelitis. |
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Definition
tenderness, pain, swelling
fever, chills, malaise, decreased motion
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Term
| t/f : you should always get a bone scan |
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Definition
true
radiographs do not normally show changes until day 14 , but bone scans will show in 1 day |
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Term
| What labs would you want to see for osteomyelitis? |
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Definition
| culture from bone aspirate, potential sources, and blood |
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Term
| Should you withhold treatment? |
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Definition
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Term
Suspected Hematogenous Pathogens
neonates |
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Definition
S. aureus
group B strrep
E. coli |
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Term
Suspected Hematogenous Pathogens
children > 1 |
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Definition
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Term
Suspected Hematogenous Pathogens
adults |
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Definition
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Term
Suspected Hematogenous Pathogens
IV drug use |
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Definition
Gram - , often in combination
think of staph aureus or staph epi (skin bugs), but generally psuedomonas sets up shop |
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Term
Suspected Hematogenous Pathogens
sickle cell |
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Definition
SAlmonella
S. aureus
Gram (-)
salmonella because of bowel infarct in GI (salmonella can enter blood here) |
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Term
Empiric Treatment of Hematogenous Osteomyelitis
< 4 months |
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Definition
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Term
Empiric Treatment of Hematogenous Osteomyelitis
> 4 mo to adult |
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Definition
VAnco + 3rd gen ceph if GNB on GS
IF no GNB then just vanc |
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Term
Empiric Treatment of Hematogenous Osteomyelitis
Adult (>21)
(vertebral) |
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Definition
Vancomycin
(SMX-TMP or linezolid) |
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Term
| What bugs are suspected in Contiguous Osteomyelitis? |
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Definition
S. aureus (most common)
multiple others:
P. aeruginosa, Strep, Ecoli, S. epidermidis
Anaerobes
Add enterococcus if they have vascular insufficiency |
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Term
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Definition
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Term
| anaerobes if previous fx or DM |
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Definition
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Term
Contiguous Treatment
Empiric without vascular insufficiency
foot bone |
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Definition
levofloxacin or cefepime
+/- vanc |
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Term
Contiguous Treatment
Empiric without vascular insufficiency
long bone |
|
Definition
vancomycin or linezolid
plus
cefepime |
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Term
Contiguous Treatment
Empiric with vascular insufficiency |
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Definition
Await culture results and treat accordinly
if acutely ill, treat like diabetic foot infection
(vanc + zosyn+ or vanc + carbopenem)
worried about MRSA and anaerobes |
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Term
| standard duration of treatment |
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Definition
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Term
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Definition
good clinical response to IV
no DM or PVD
Compliance is assured |
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Term
How do you know you have a clinical cure?
Should you do a follow up bone aspiration? |
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Definition
clinical findings no longer present
clinical findings (WBC, ESR, inflammation)
ESR normal
No, you would be an a-hole to do that to someone again
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Term
| T/f: recurrence is a major issue |
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Definition
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Term
| from the case...if a culture grows out pseudo...what do you do? |
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Definition
can treat SPACE bugs with two drugs initially
beta lactam plus FQ or AG |
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