DRGauravJain

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9111464959https//www.drgauravjain.com

• Dr Gaurav Jain
• 20 B Sainath Colony , Indore

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What is Osteomyelitis?

• Osteomyelitis in the pediatric population is most
  often the result of hematogenous seeding of
  bacteria to the metaphyseal region of bone.
• Diagnosis is generally made with MRI studies to
  evaluate for bone marrow edema or subperiosteal
  abscess.
• Treatment is nonoperative with antibiotics in the
  absence of an abscess. Surgical debridement is
  indicated in the presence of an abscess.

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What Causes Osteomyelitis?

• Pathophysiology
• Staph aureus
• is the most common organism in all children
• strains of community-acquired (CA) MRSA have
  genes encoding for Panton-Valentine leukocidin
  (PVL) cytotoxin
• PVL-positive strains are more associated with
  complex infections, multifocal infections,
  prolonged fever, abscess, DVT, and sepsis
• MRSA is associated with an increased risk of DVT
  and septic emboli
• Group B Strep
• is most common organism in neonates
• Kingella kingae
• becoming more common in younger age groups

• Pseudomonas
• is associated with direct puncture wounds to the
  foot
• H. influenza
• has become much less common with the advent of
  the Haemophilus influenza vaccine
• Mycobacteria tuberculosis
• children are more likely to have extrapulmonary
  involvement
• biopsy with stains and culture for acid-fast
  bacilli is diagnostic
• Salmonella
• more common in sickle cell patients

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What are Factors for Osteomyelitis?

• Incidence
• 1 in 5000 children younger than 13 years old 13
  ??? ?? ?? ???? ?? 5000 ?????? ??? ?? 1
• Demographics
• mean age 6.6 years ??? ??? 6.6 ????
• 2.5 times more common in boys ?????? ??? 2.5 ????
  ???? ??
• more common in the first decade of life due to
  the rich metaphyseal blood supply and immature
  immune system ???? ??? ??? ????
• not uncommon in healthy children ?????? ??????
  ??? ???????? ????

• Risk factors 
• diabetes mellitus ??????
• hemoglobinopathy ????????????????
• juvenile rheumatoid arthritis ?????
• chronic renal disease ?????? ?? ??????
• immune compromise ?????????? ?? ???
• varicella infection ???????
• Mechanism
• local trauma and bacteremia lead to increased
  susceptibility to bacterial seeding of the
  metaphysis
• history of trauma is reported in 30 of patients

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What is treatment of Osteomyelitis?

• Nonoperative treatment
• antibiotic therapy alone 
• indications
• early disease with no subperiosteal abscess or
  abscess within the bone 
• surgery is not indicated if clinical improvement
  obtained within 48 hours 
• modalities
• antibiotics
• begin with empiric therapy
• generally, nafcillin or oxacillin, unless high
  local prevalence of MRSA (then use clindamycin or
  vancomycin)
• mechanism of action for vancomycin involves
  binding to the D-Ala D-Ala moiety in bacterial
  cell walls
• if gram stain shows gram-negative bacilli add a
  third generation cephalosporin
• convert to organism-specific antibiotics if
  organism identified
• mycobacterium tuberculosis
• treatment for initial 1 year is multiagent
  antibiotics and rarely surgical debridement due
  to risk of chronic sinus formation
• duration
• typically treat with IV antibiotics for four to
  six weeks, ?? ??? ?? ??? ?? ?? ?????? ?? ??? IV
  ??????????? ??? ?? ???? ??
• controversial duration
• intravenous versus oral
• often a case by case decision with input from
  infectious disease consultation

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• surgical drainage, debridement, and antibiotic
  therapy
• indications
• deep or subperiosteal abscess ????? ??? ???? ??
  ?????? ????
• failure to respond to antibiotics ???????????
  ????? ?? ???? ???? ??? ??????
• chronic infection ???? / ?????? ???????
• contraindications
• hemodynamic instability, as patients should be
  stabilized first however sometimes operative
  treatment of the underlying infection helps
  stabilize the patient

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Contact Dr Gaurav Jain

• 20 B Sainath Colony , Indore
• 9111464959
• https//www.drgauravjain.com