Bone Infection Flashcards by Sara Fieger

localized infection of bone marrow

osteomyelitis

occurs when bone integrity is interrupted

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osteomyelitis occurs due to (3)

hematogenous spread
contagious spread (adjacent structures/joints)
direct inoculation (sx, trauma)

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hematogenous osteomyelitis

after bacteremia

typically mono microbial

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hematogenous osteomyelitis mc affects?

vertebrae in adults (IVDA)

long bones in children and infants

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mc organisms of hematogenous osteomyelitis

staph aureus

pseudomonas and enterobacter

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hematogenous osteomyelitis patho

beings inside bone and grows towards cortex (perosteal elevation)

inflammation of overlying soft tissue and sinus track development to drain thru skin

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contagious or direct inoculation osteomyelitis

MC from trauma and vascular dz

polymicrobial

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post trama osteomyelitis

MC adults, in tibia, due to S. aureus

begins OUTSIDE cortex and works its way towards medullary canal

abscess increases pressure and compromises O2 delivery = expand and growth of more bacteria

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osteomyelitis due to vascular disease

MC due to inadequate inflammatory respond to minor trauma and invasion of multiple organisms to feet

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osteomyelitis due to vascular disease pathogens

strep species 
entroecoccus 
coagulase postive and negative staphylococci 
gram neg bacilli
anerobic organisms

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acute osteomyelitis

less than 2 weeks, MC in kids

several days of dull pain, LOCALIZED tenderness, warmth and swelling, systemic symptoms

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children with acute osteomyelitis

decreased ROM of extremity and pain

malaise

fevers

irritability

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chronic osteomyelitis

2-3 months, MC in adults

pain, redness, swelling, DRAINING sinus tract

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DM osteomyelitis

exposed bone or large ulcer (>2x2 cm) OR if bone is palpable on exam = LIKELY osteomyelitis

ESR > 60 also indicated

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overall, ____ is mc etiologic agent in direct inoculation and hematogenous spread osteomyelitis

staphylococcus

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bones affected by osteomyelitis DM

tarsal
metatarsal
phalanges

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bones affected by osteomyelitis neonates, children

long bones (hematogenous spread_

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bones affected by osteomyelitis CABG

sternum

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bones affected by osteomyelitis endocarditis

vertebral bodies (diskitis)

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osteomyelitis predisposing factors

DM
IVDA 
ulcers 
trauma 
surgery 
hx of prosthesis

osteomyelitis PE

evaluate ulcers to “probe to bone” - assume osteomyelitis

pathognomonic osteomyelitis

sinus tract drainage

osteomyelitis WU

CBC
blod culture
wound culture

BONE BX and CuLTURE = golds standard

osteomyelitis imaging

plain films first

MRI test of choice (After plain films) to determine if soft tissue or bone infxn

osteomyelitis tx

abx (parenteral) and possible sx AFTER culture

surgery is indicated for osteomyelitis :

1. failure of abx 2. infected surgical hardware 3. chronic osteomyelitis w/necrotic bone and soft tissue 4. clear necrotic tissue at an ulcer site

osteomyelitis ABX

quinalones have a high degree of bone penetration typically do Vanco + fluroquinaolone

osteomyelitis adjunctive tx

HBO NPWT (wound vac) +/- re-vascualrization (vascular insufficiency)

long term chronic osteomyelitis

squamous cell carcinoma or fibrosarcoma

septic arthritis

infection fo joint space acute mono-articular arthritis (single, swollen joint)

RF of septic arthritis

``` DM immunosuppresive tx prosthetic hardware recent joint sx IVDA, alcoholism sexually active young ```

sources of infection septic arthritis

trauma hematogenous spread surgical infection

pathogenesis septic arthritis

bacteria enter joint via various mechanisms and produce inflammatory response = swelling, erythema, and warmth of joint space

MC pathogens in septic arthritis

Staph aureus overall N. gonorrhea in young, sexually active adults

septic arthritis where

MC in knee | next hip

polyarticular septic arthritis

20% of case present with this MC see overwhelming sepsis

pediatrics and septic arthritis

lower extremity joints

acute septic arthritis differential

monoarticular = septic arthritis or gout poly articular = reactive arthritis or viral arthritis

chronic septic arthritis (>12 weeks)

mono= osteoarthritis | poly - osteoarthritis or RA

septic arthritis exam

fever, chills, rigors, systemic symtoms joint pain, swelling, warmth, restricted ROM hot, red painful joint

septic arthritis diagnosis

acute, hot painful joint CBC, blood culture, ESR, CRP XR normal

diagnostic study of choice for septic arthritis

arhtrocentesis to evaluate fluid visualization, stain and culture, leukocyte could and glucose level

septic arthritis arthrocentesis results

``` opaque >3.5 volume leukocytes 15-100k often POSITIVE <25 ```

septic arthritis tx

vanc + ceftriazone IV x 4-6 weeks ortho consult and consideration for debridement

stage I septic arthritis

remove prothesis and place a spacer six weeks of ABX (often all IV)

stage II septic arthritis

placement of new prosthesis with antibiotic impregnated cement (95% success)

septic arthritis prognosis

not much change difficult to predict final outcome polyarthrtiic joint higher mortality rate

predictors for poor outcome septic arthritis

old age preexisting dz synthetic material