Flashcards in Osteomyelitis Deck (29):
What is Osteomyelitis?
Inflammation of the bone, often due to Infection.
Usually presents in long bones (especially the medullary cavity)
Can Recur after treatment
How can Osteomyelitis be categorised?
Time: Acute (<6 weeks) or Chronic (>6 weeks)
Spread: Haematogenous/Contiguous/Direct Inoculation
In which patients is Salmonella-Causative Osteomyelitis common in?
Sickle Cell Patients
N.B. Staph. Aureus is also common
What is a GENERAL clinical presentation of Osteomyelitis?
Localised Bone Pain
IF YOU CAN SEE A TENDON, IT IS OSTEOMYELITIS
What is a bone change characteristically seen in pyogenic osteomyelitis?
Results from the stripping-off of the periosteum from accumulation of pus within the bone and new bone growing from the periosteum
What are CLASSIC investigations done in Osteomyelitis?
Bone Cultures (via Percutaneous Aspiration or Deep Bone)
How does Open Fracture Osteomyelitis present?
How does it occur?
Poor Wound Healing
Occurs due to Contiguous Spread of infection
What are common bugs in Open Fracture Osteomyelitis?
Aerobic Gram Negatives
What is treatment for Open Fracture Osteomyelitis?
Aggressive Surgical Debridement to remove infected tissue and pus
Soft Tissue Cover: IV Co-Amoxiclav and Metronidazole
How does Diabetic Venous Insufficiency Osteomyelitis occur?
What are common bugs for Diabetic Venous Insufficiency Osteomyelitis?
Staph. Aureus most common
What are Signs for Diabetic Venous Insufficiency Osteomyelitis?
WILL GET INFECTION IF WOUND IS >2cm FOR >2 MONTHS
Positive Probe-to-Bone Test
High Inflammatory Marker Levels
What is treatment for Diabetic Venous Insufficiency Osteomyelitis?
What antibiotics are used in Diabetic Venous Insufficiency Osteomyelitis?
Mild: Flucloxacillin (if penicillin allergy, Vancomycin)
Moderate: Oral Flucloxacillin + Metronidazole
Severe: IV Flucloxacillin, Gentamycin
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
In which patients is Haematogenous Osteomyelitis more common?
IV Drug Users
Central Lines/Dialysis Patients
What are COMMON bugs in IV Drug User Haematogenous Osteomyelitis?
What are UNUSUAL bugs in IV Drug User Haematogenous Osteomyelitis?
Eikenella Corrodens (needle lickers)
What will characteristic of IV Drug User Osteomyelitis?
Osteomyelitis in unusual sites e.g. Sternoclavicular Joint, Sacroiliac Joint, Pubic Symphysis etc.
What are common bugs in Central Line/Dialysis Patient Osteomyelitis?
Aerobic Gram Negatives
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
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
What are potential causers of Clavicular Osteomyelitis?
Subclavian vein catheterisation
Vertebral Osteomyelitis is mostly Haematogenous. True/False?
What are associations of Vertebral Osteomyelitis?
IV Drug Use
Infection (IV Sites/GU Tract/SSTI/Post Operative)
What are symptoms of Vertebral Osteomyelitis?
Systemic Upset e.g. Fever etc.
Insidious Back Pain/Tenderness
Raised Inflammatory Markers
Paraspinal Muscle Spasm
What are investigations of Vertebral Osteomyelitis?
Biopsy (consider open biopsy is first 2 do not show much)
What is treatment of Vertebral Osteomyelitis?
Surgical Drainage of Abscess
Antimicrobials for 6 Weeks
(extend duration in complex cases)