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Flashcards in Osteomyelitis Deck (29):
1

What is Osteomyelitis?

Inflammation of the bone, often due to Infection.

Usually presents in long bones (especially the medullary cavity)

Can Recur after treatment

2

How can Osteomyelitis be categorised?

Time: Acute (<6 weeks) or Chronic (>6 weeks)

Spread: Haematogenous/Contiguous/Direct Inoculation

3

In which patients is Salmonella-Causative Osteomyelitis common in?

Sickle Cell Patients

N.B. Staph. Aureus is also common

4

What is a GENERAL clinical presentation of Osteomyelitis?

Localised Bone Pain
Malaise
Fever
Night Sweats

IF YOU CAN SEE A TENDON, IT IS OSTEOMYELITIS

5

What is a bone change characteristically seen in pyogenic osteomyelitis?

Involucrum

Results from the stripping-off of the periosteum from accumulation of pus within the bone and new bone growing from the periosteum

6

What are CLASSIC investigations done in Osteomyelitis?

Bone Biopsy

Bone Cultures (via Percutaneous Aspiration or Deep Bone)

MRI

7

How does Open Fracture Osteomyelitis present?
How does it occur?

Non-Union
Poor Wound Healing

Occurs due to Contiguous Spread of infection

8

What are common bugs in Open Fracture Osteomyelitis?

Staph. Aureus
Aerobic Gram Negatives

9

What is treatment for Open Fracture Osteomyelitis?

Aggressive Surgical Debridement to remove infected tissue and pus

Fixation

Soft Tissue Cover: IV Co-Amoxiclav and Metronidazole

10

How does Diabetic Venous Insufficiency Osteomyelitis occur?

Contiguous Spread

11

What are common bugs for Diabetic Venous Insufficiency Osteomyelitis?

Often Polymicrobial!

Staph. Aureus most common
Gram Negatives

12

What are Signs for Diabetic Venous Insufficiency Osteomyelitis?

Chronic/Indolent/Deep Ulcer
WILL GET INFECTION IF WOUND IS >2cm FOR >2 MONTHS

Positive Probe-to-Bone Test

High Inflammatory Marker Levels

13

What is treatment for Diabetic Venous Insufficiency Osteomyelitis?

Surgical Debridement

Antimicrobials

14

What antibiotics are used in Diabetic Venous Insufficiency Osteomyelitis?

Mild: Flucloxacillin (if penicillin allergy, Vancomycin)

Moderate: Oral Flucloxacillin + Metronidazole

Severe: IV Flucloxacillin, Gentamycin

15

How long should antibiotics be given in Diabetic Venous Insufficiency Osteomyelitis?

7 Day: SSTIs
14 day: Bacteremia
6 weeks: Osteomyelitis (2 weeks IV, 4 weeks Oral)

Consider this for other forms of Osteomyelitis too

16

In which patients is Haematogenous Osteomyelitis more common?

IV Drug Users
Prepubertal Children
Central Lines/Dialysis Patients
Elderly

17

What are COMMON bugs in IV Drug User Haematogenous Osteomyelitis?

Staph. Aureus
Streptococci

18

What are UNUSUAL bugs in IV Drug User Haematogenous Osteomyelitis?

Pseudomonas
Candida
Mycobacterium TB
Eikenella Corrodens (needle lickers)

19

What will characteristic of IV Drug User Osteomyelitis?

Osteomyelitis in unusual sites e.g. Sternoclavicular Joint, Sacroiliac Joint, Pubic Symphysis etc.

20

What are common bugs in Central Line/Dialysis Patient Osteomyelitis?

Staph. Aureus
Aerobic Gram Negatives

21

What is treatment for Haematogenous Osteomyelitis?

14 days Antibiotics

Wait for lab results UNLESS THERE IS SEPSIS RISK, then start from day 1 of positive culture

22

What factors need to be considered with Aseptic Osteitis Pubis?

Triggered by surgery

Presentation can be up to 18 months later

Athletes can get it

23

What are potential causers of Clavicular Osteomyelitis?

Neck surgery

Subclavian vein catheterisation

24

Vertebral Osteomyelitis is mostly Haematogenous. True/False?

True.

25

What are associations of Vertebral Osteomyelitis?

Psoas/Epidural Abscess
IV Drug Use
Infection (IV Sites/GU Tract/SSTI/Post Operative)
Diabetes
Immunosuppression

26

What are symptoms of Vertebral Osteomyelitis?

Systemic Upset e.g. Fever etc.
Insidious Back Pain/Tenderness
Neurological Symptoms
Raised Inflammatory Markers
Paraspinal Muscle Spasm

27

What are investigations of Vertebral Osteomyelitis?

MRI

FBC

Biopsy (consider open biopsy is first 2 do not show much)

28

What is treatment of Vertebral Osteomyelitis?

Surgical Drainage of Abscess

Antimicrobials for 6 Weeks
(extend duration in complex cases)

29

Antibiotics should be given in all osteomyelitis presentations. True/False?

Tricky one, but true!
DO NOT USE EMPIRICAL ANTIBIOTICS!

In Acute Osteomyelitis, treat with IV Flucloxacillin + Gentamycin + Metronidazole

In Chronic Osteomyelitis, treat with Oral Flucloxacillin