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OSTEOMYELITIS (Monitoring (Culture and susceptibility prior to ABX…
OSTEOMYELITIS
Monitoring
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CRP and ESR - weekly, may take several weeks to show improvement
inflammation, fever, redenss, pain, swelling, tenderness daily to indicate symptom improvement - if no improvement/resolution abscess suspicion
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Epidemiology
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Diabetes, prosthetic joints = risk factors
Can be caused by contiguous spread, post-op contamination, direct puncture trauma, adjacent soft tissue spread, spread from blood stream = hematogenous
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Most common organisms is S. aureus, contiguous more likely to be polymicrobial
Radiologic/Lab Tests
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CT or PET scan if MRI cannot be done (metal joint, etc.)
Lab tests - ESR, C-reactive protein, WBC
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Pathophysiology
Hematogenous - common in children, or vertebrae of adults. Occurs from bacteria settling in bends of arterioles due to slower blood flow through those spots --> bacteria settle--> inflammatory response --> avascular necrosis and exudate can occur. Most common in long bones
Direct inoculation - caused by penetration, entrance of organisms from exogenous source
Contiguous Spread - adjacent soft tissue; pressure ulcers; diabetic foot infection; more common in >50 yo
Chronic Osteomyelitis - large segment of bone becomes avascular and necrotic, can occur from improper wound debridement
Treatment
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Targeted
MSSA
Nafcillin, Oxacillin, Cefazolin, Flucloxacillin, Ceftriaxone
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Gram Neg
Cipro, Levo, ceftriaxone, ceftazidime, cefepime, ertapenem, meropenem
Enterococci
ampicillin, Pen G, Vanc, dapto, ampicillin+ceftriaxone
Streptococci
Pen G, ampicillin, ceftriaxone, vanc
Duration
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If s/sx still present, extend therapy
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Surgical debridement, hyperbaric oxygen, abx impregnated implants may be necessary
Etiology
Mode of acquisition: blood-hematogenous, adjoining tissue-contiguous
Hema - more likely to infect just one bone, contig - more likely to infect multiple bones
Classified by duration - acute ~1 week, chronic >1 month
S/Sx
Hematogenous - tenderness, pain, swelling, fever, chiils, malaise, decreased motion
Vertebral - chronic back pain, fever/night sweating, weight loss, neurologic complications and nerve pain
Contiguous - tenderness, warmth, edema, erythema
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