OSTEO MYELITIS AND INFECTION Odfu

Question 1

Two key features of infection?

Answer 1

• Characterised to subcutaneous or deeper
• The severity of infection dependent on location and depth, tendon, muscle bone

Question 2

Diagnosis of OM and soft tissue infection

Answer 2

Clinical sign:
- Wound secretion or bubbling clear fluid
-Inflammation with swelling and erythema, blood serum secretion
Systematic inflammatory response syndrome
- Width and depth of the wound –> deep ulcer are more associated with OM
- Infected ulcer+ Probe to bone test –> highly suspicious
-Probe to bone test+ X ray –> highly accurate
-Laboratory markers: WBC, CRP, ESR, Procalcitonin
-Gold standard: Bone biopsy for diagnosis of OM
-X-ray is not accurate when OM is at the initial stage. MRI has a higher sensitivity or Use when OM is in doubt
-Sample for culture to determine the causative micro organism

Question 3

Cellulitis

Answer 3

• Bacterial infection of the skin

Question 4

Infection hospitalisation guideline?

Answer 4

Diabetes and severe foot infection should be hospitalised

Question 5

treatments of osteomyelitis

Answer 5

dscision of risk and benefits and patient eligibility:
Surgical: complete removal of infected bone, reduced anti biotic duration, impaired biomechanics,
reduced risk of SRIS, reduce risk of amputation

Antibiotic:
risk of recurrence
difficult to define completely clearance of OM
risk of further deterioration
long effect of ABx-side effect

Question 6

Diagnosis of OM

Answer 6

-Consider a sample for culture to determine the causative microorganism- Preferable by aseptically collecting a tissue speciman

Question 7

Anti biotic regimes for treating OM

Answer 7

• Administer antibiotics for a duration of 1 to 2 weeks
• Consider continuing treatment to 3 to 4 weeks if the infection is improving
  -if the infection has not resolved ater 4 weeks of abX- re-evaluate the patient and reconsider the need for further diagnostic studies

Question 8

How does OM look like in X ray

Answer 8

Loss of bone cortex with bony erosion
bone scelrosis with or without erosion

Question 9

Antibiotic regime after minor amputation?

Answer 9

-duration of upto 3 weeks after minor amputation with positive bone margin culture
-6 weeks for diabetes related OM without one resection