Osteomyelitis Flashcards
(48 cards)
Osteomyelitis - definition
Infection in bone
Acute Osteomyelitis - definition
Associated with inflammatory bone changes by pathogenic bacteria and s/s typically present within 2 weeks after infection
Chronic Osteomyelitis - definition
Necrotic bone with s/s that may not occur until 6 weeks after the onset of infection
Generally secondary to open fx, bacteremia or contiguous bone infection
How does Osteomyelitis occur
Hematogenous dissemination of bacteria
Invasion from a contiguous focus of infection
Skin breakdown in the setting of vascular insufficiency
Where does Osteomyelitis occur
Spine Cancellous portions of long bones Pelvis Calvicle Previously injured bone or bone in close proximity to area of infection
Who does Osteomyelitis occur in?
Peds
- etiology is uslaly hematogenous
- most common anatomic area - vascular metaphysis of long bones
Adults
- innoculation of organism through open fx or sx fixation of fx
- hematogenous is much less common than in kids - if it occurs, will be in the vertebra, long bones, pelvis or clavicle
Organisms of Osteomyelitis in peds
S. aureus - most common Group A beta-hemolytic strep Others - Strep penumonia - H. flu (less prevalent now) - Kingella Kingae - Group B strep infection (newborns)
Organisms of Osteomyelitis in adults
S. aureus - most common Pseudomonas aeruginosa MRSA Staph epidermidis Serratia marcescens E. coli Atypical organisms in immunocompromised pts Others - M. TB - Candida species - Coccidoidomycosis immitis
RF for Hematogenous Osteomyelitis
Children Sickle cell dz IV drug use DM Chronic Renal Dz Elderly
Why are children at risk for hematogenous Osteomyelitis
Metaphyseal regions of long bones are highly vascular and susceptible to minor trauma
> 50% of acute hematogenous osteomyelitis are in pts <5yo
Organism most common for hematogenous osteomyelitis in sickle cell dz pts
Salmonellae
IV drug use and hematogenous osteomyelitis
Typically osteomyelitis of the spine
S. aureu (most common) then Gram negative, esp. P. aerginose and Serratia species
The elderly and hematogenous osteomyelitis
Thoracic and lumbar vertebra RF - DM - IV catheters - Urinary catheters
Causes of soft tissue infections that can spread to the bone
Prosthetic joint replacement Pressure ulcer Neuro sx Trauma Septic arthritis Cellulits
Vascular insufficiency and osteomyelitis
Pts with DM or vascular insufficiency at greatest risk
Foot and ankle are most likely sites
Infection originates from ulcer or skin breakdown
Big source of chronic osteomyelitis
Vascular insufficiency & osteomyelitis - symptoms
Chronic pain Persistent sinus tract or wound drainage Poor wound healing Malaise Sometimes fever
Vascular insufficiency and osteomyelitis - important clues
Pass sterile probe through ulcer to bone
Ulcer >2cm*cm
Polymicrobial infections of vascular insufficiency and osteomyelitis
S. aureus
Staph epidermidis
Clinical Presentation - neonates
Vague s/s Malaise Lethargy Pseudo-paralysis Excessive crying Irritability Fever Local swelling Pain with palpation
Clinical presentation - children
Fever
Pain
Swelling of infected site
Clinical presentation - Adults (hematogenous)
Back pain along with Hx of DM Ca Chronic renal dz IV drug use
Clinical presentation - Adults (vascular insufficiency with DM)
Chronic pain Persistent sinus tract or wound drainage Poor wound healing Malaise Sometimes fever
Clinical presentation - Adults (Typical s/s)
Fever Pain Lethargy Malaise Swelling of infected site
Clinical presentation - Adults (hx of fx)
Drainage or delay in fx healing
