osteomyelitis

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osteomyelitis

• kendra morrison
• em pgy 4
• sjhc

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etiology

• hematogenous seeding
• monomicrobial most common site is metaphysis
• occurs more commonly in kids (long bones) than
  adults (vertebrae)
• contiguous spread of infxn from skin/joints
• polymicrobial
• occurs more in young people (trauma) and older
  people (decub. ulcers infected total joints)
• direct innoculation from trauma/surgery
• polymicrobial
• acute vs. chronic

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classification

• Lee Waldvogel
• based on duration of illness mechanism
• Cierny Mader
• based on affected portion of bone, physiologic
  status of host local environment (stage 1-4)

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microbiology

• staph aureus
• coag-neg staph
• aerobic gm-neg bacilli
• less common
• streptococci
• enterococci
• anaerobes
• fungi
• mycobacteria

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clinical presentation

• acute
• gradual onset of sxs (may present as septic
  arthritis esp. if metaphysis of bone involved is
  located in joint capsule) (ex knee, hip,
  shoulder)
• dull pain at site
• warmth, erythema swelling at site
• fever /- rigors
• subacute
• pain over several weeks
• minimal fever or other constitutional sxs

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• chronic
• pain, erythema, swelling or draining sinus tract
  (pathognomic)
• deep or non-healing ulcers should raise suspicion
  for osteo (esp. if ulcers lie over bony
  prominences)
• diabetics can present atypically
• (2X2)

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diagnosis

• bone biopsy to ID pathogen (pos. findings in 87
  of cases) do at time of surg. debridement
• may not need in setting of pos. blood cxs pos.
  radiographic findings
• cxs of superficial wounds/sinus tracts do not
  often yield same causative agent, so not useful
• xrays (plain films of affected area)
• labs
• cbc (leukocytosis in acute but not in chronic)
• esr/crp (may be elev. or normal)
• blood cxs (more commonly pos. in hematogenous)

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treatment

• surgical debridement
• antimicrobial therapy (table 2)
• gm negs fluoroquinolones
• rifampin has activity at the biofilm but req.
  2nd agent secondary to emerging resistance
• hardware removal
• hyperbaric oxygen
• wound vac

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