Osteomyelitis

Question 1

Which bone is MC affected in kids?

Which bone is MC affected in adults?

Answer 1

Kids: femur and tibia

Adults: vertebrae

Question 2

There are three ways this infection can progress. What is the MC way?

What are the other two ways?

Answer 2

-Acute hematogenous spread: MC route in kids

-Direct inoculation: post traumatic, infection close to bone, surgical (prosthetic joints)
-Contigous spread with vascular problems: DM, PVD

Question 3

Notable Organisms
-MCC overall
-Prosthetic joint placement
-Sickle-cell disease
-neonates
-puncture wounds through tennis shoes

Answer 3

-MCC overall: Staph A
-Prosthetic: Staph epidermis
-Sickle Cell: Salmonella
-Neonates: Group B Strep
-Puncture: Pseudomonas

Question 4

What diagnostics should you obtain if you suspect osteomyelitis?

Answer 4

-Labs: increased ESR and CRP
-Radiographs (initial imaging): periosteal reaction if early.
-MRI: most sensitive in early disease
-Bone aspiration: Gold standard

Question 5

What is the gold standard diagnostic for osteomyelitis?

Answer 5

Bone aspiration

Question 6

True or False: radiographs may be negative for up to 2 weeks after symptom onset?

Answer 6

True**

Question 7

How long should you treat someone with suspected osteomyelitis and how many weeks should be IV?

Answer 7

4-6 weeks with at least 2 weeks IV

+/- debridement

Question 8

ABX Therapies
-Birth - 3 months:
-> 3 months - adults
–MSSA (Staph Aureus)
–MRSA
-Sickle Cell
-Puncture Wound

Answer 8

-Birth - 3 months: Group B Strep = Cefotaxime + Vanco/Oxacillin/Nafcillin

-> 3 months - adults (MSSA) = Nafcillin, Oxacillin, Cefazolin (Clinda or Vanco if PCN allergic)

-> 3 months - adults (MRSA) = Vanco/Clinda/Linezolid

-Sickle Cell = Salmonella

Question 8

ABX Therapies
-Birth - 3 months:
-> 3 months - adults
–MSSA (Staph Aureus)
–MRSA
-Sickle Cell
-Puncture Wound

Answer 8

-Birth - 3 months: Group B Strep = Cefotaxime + Vanco/Oxacillin/Nafcillin

-> 3 months - adults (MSSA) = Nafcillin, Oxacillin, Cefazolin (Clinda or Vanco if PCN allergic)

-> 3 months - adults (MRSA) = Vanco/Clinda/Linezolid

-Sickle Cell: Salmonella = Ceftriaxone, Ceftazidime, Cefotaxime

-Puncture Wound: Pseudomonas = Ceftazidime or Cefepime, Ciprofloaxin

Question 9

On the other hand, with chronic osteomyelitis (months to years), what should you expect to see on radiographs?

Answer 9

Sequestrum (segments of necrotic bone) and Involucrum (new periosteal bone formation surrounds necrotic bone (sequestrum)).

Question 10

Treatment for chronic osteomyelitis

Answer 10

-Surgical debridement and cultures
–Then ABX based on culture and sensitivity