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Osteomyelitis
From WikEM
Contents
Background
- Infection of the bone by bacteria or fungus
- Etiology
- Contiguous spread (80%)
- Hematogenous spread (20%)
- More common in pediatric (long bones)
- Less common in adults (spine)
Risk Factors
- Diabetic patients with one or more of the following:
- Skin ulceration >2cm
- Positive probe-to-bone test
- ESR >70 (83-92% Sn)
- Abnormal x-ray
Clinical Features
- Pain at the site
- May also have warmth, swelling, erythema
Differential Diagnosis
Skin and Soft Tissue Infection
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
Evaluation
- X-ray
- May be normal early in the course
- Later will show bone demineralization, periosteal elevation, lytic lesions
- Blood culture
- MRI is the standard for diagnosis (as early as 3-5 days after infection)[1]
- Bone scan is sensitive, but lacks specificity vs. MRI
Management
| Risk Factor | Likely Organism | Initial Empiric Antibiotic Therapy' |
| Elderly, hematogenous spread | MRSA, MSSA, gram neg | Vancomycin 1gm + (Piperacillin/Tazobactam 3.375 grams OR imipenem 500mg) |
| Sickle Cell Disease | Salmonella, gram-negative bacteria | Ceftriaxone 50mg/kg IV once daily OR Cefotaxime 50mg/kg IV three times daily, PLUS
|
| DM or vascular insufficiency | Polymicrobial: Staph, strep, coliforms, anaerobes | Vancomycin 1gm + (Piperacillin/Tazobactam 3.375 grams OR imipenem 500mg) |
| IV drug user | MRSA, MSSA, pseudomonas | Vancomycin 1gm |
| Newborn | MRSA, MSSA, GBS, Gram Negative | Vancomycin 15mg/kg load, then reduce dose, AND ceftazidime 30mg/kg IV q12 h |
| Children | MRSA, MSSA | Vancomycin 10mg/kg q6 h AND ceftazidime 50mg/kg q8hr |
| Postoperative (ortho) | MRSA, MSSA | Vancomycin 1gm |
| Human bite | Strep, anaerobes, HACEK organism | Piperacillin/Tazobactam 3.375gm OR imipenem 500mg |
| Animal bite | Pasteurella, Eikenella, HACEK organism | Piperacillin/Tazobactam 3.375gm OR imipenem 500mg |
See Also
References
- ↑ Pineda C et al. Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy. Semin Plast Surg. 2009 May; 23(2): 80–89.
