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Osteomyelitis - Coggle Diagram
Osteomyelitis
Epidemiology
Inflammation/destruction of bone due to infection
Usually bacterial
Acute osteomyelitis
Days-weeks
Chronic osteomyelitis
Months-years
Persistence of (less virulent) microorganisms
Low-grade inflammation
Sequestrum (dead bone)
Surgical debridement required
Fistulous tracts
Causative Organisms (Haematogenous osteomyelitis)
Adults
Staph. aureus
Streptococci
Gram - bacteria
E. Coli
Pseudomonas
Klebsiella
Proteus
Children
Staph. aureus
Streptococcus pyogenes
Kingella kingae
<4 yrs age
Strep. pneumoniae
H. influenzae
tybe B
Unvaccinated
Salmonella
Neonates
Staph. aureus
Group B streptococci (
S. agalactiae
)
E. Coli
Risk factors (Haematogenous osteomyelitis)
Adults
Elderly
Immunocompromised
IV drug use
Indwelling lines
Sickle cell disease
Salmonella
S. pneumoniae
Clinical Manifestations
Often insidious onset
Local
Pain
May be the only symptom depending on site
Children
Pseudoparalysis
Soft tissue swelling later
Erythema
Swelling
Heat
Systemic
Fever
More common in children
Sepsis
Acute
Onset over days
Chronic
Longer history
May have draining sinus tract
Diagnosis
History
Examination
Investigations
Blood cultures
Since many cases caused by haematogenous infections
Bone samples
Gold standard!
Culture
Susceptibility testing
+/- molecular testing/PCR
Radiology
X-ray
Can't tell difference between new and recurrent osteomyelitis
MRI
CT
Pathogenesis
Haematogenous
More common in children
Long bones
Adults
Vertebrae
Vertebral Osteomyelitis
+/- epidural/paravertebral abscess
Sources of infection
GU tract
Renal abscess
Infected iV sites
IV drug use
Skin/soft tissue infections
Enndocarditis
Causative organisms
Same as haematogenous osteomyelitis
Staph and strep.
M. tuberculosis
Pott's disease
Brucella
Endemic areas
Usually monomicrobial
Transient bacteraemia
Bacteria enter metaphysis (long bones)
Inflammation in metaphysis
Exogenous
Contiguous
Infected ulcers
Diabetic foot ulcers
Diabetic Foot Osteomyelitis
Contributing factors
Metabolic abnormalities
Vascular insufficiency
Bone/soft tissue ischaemia
Neuropathy
Causative organisms
Mono or polymicrobia
Staph. aureus
Streptococci
Enterococci
Gram - bacteria
Anaerobes
Soft tissue infection spread to bone
Diagnosis
Probe-to-bone test
Adjacent prosthetic joint infection
Direct inoculation
Trauma
Surgery
More common in adults
Causative organisms
Staph. aureus
(including MRSA)
Streptococci
Beta-hemolytic streptococci
Enterococci
Gram - bacteria
E. Coli
Pseudomonas
Klebsiella
Proteus
Anaerobes
Fungi
Can be polymicrobial
Treatment/Prevention
Antibiotics
If possible, delay until culture samples taken
Child > 3 months
Kingella kingae
H. influenzae
Streptococci
Staph. aureus
Flucloxacillin +/- Ceftriaxone
Child < 3 months
E. Coli
Group B streptococci
Staph. aureus
Flucloxacillin +/- Cefotaxime
Empiric therapy
MRSA
Vancomycin
Other streptococci
Group A streptococci
Flucloxacillin +/- Benzylpenicillin
If risk for gram - infection
Add Ciprofloxacin/Ceftriaxone
Staph. aureus
Surgery
Debridement of necrotic tissue
Drainage of abscess
Fractures
Removal of prosthetic material
