Osteomyelitis Flashcards

1
Q

What are the four main causes of osteomyelitis?

A
  1. Surgery
  2. Diabetes
  3. Peripheral vascular dz
  4. Trauma
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2
Q

What would clue you into an osteomyelitis with a hematogenous spread?

A
  • single bone
  • metaphysis
  • no single obvious site
  • single pathogen isolate
  • Usually in the tibia or femur
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3
Q

What is the clinical presentation of someone with osteomyelitis?

A
  1. fever/chills/malaise

2. restricted movement, pain/tenderness in neck/back (90%)

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4
Q

What are common pathogens in vertebral osteomyelitis?

A
  1. Staph aureus
  2. Viridans strep
  3. enterococci
  4. E. Coli
  5. Salmonella in a SICKLE CELL pt
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5
Q

What are risk factors for vertebral osteomyelitis?

A
  1. Age>50
  2. Sickle cell dz
  3. diabetes
  4. hemodialysis
  5. trauma
  6. UTI
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6
Q

How do you diagnose vertebral osteomyelitis?

A
  1. positive cultures
  2. X Rays (erosion of end plates)
  3. CT/MRI scan for abscesses
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7
Q

What are the two types of contiguous focus osteomyelitis?

A

with and without vascular insufficiency. If vascular insufficiency is present, SMALL BONES OF FEET involved.

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8
Q

What pathogen is common in contiguous focus osteomyelitis?

A

Staph aureus! Often polymicrobial or gram - aerobic (pseudomonas)

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9
Q

What bug affects prostheses?

A

coagulase negative staph

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10
Q

What labs are relevant in osteomyelitis?

A
  1. blood culture
  2. ESR
  3. CRP (acute phase protein)
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11
Q

How long do you treat osteomyelitis for?

A

Either 4-6 weeks or until CRP is normal or ESR < 2/3 of entering value.

–always culture before starting antimicrobial therapy!

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12
Q

When will you see X ray changes in cases of osteomyelitis?

A

After 10 days of infection, usually in periosteum. If you see lytic changes, it’s been 2-6 weeks

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13
Q

What other imaging could you use?

A
  1. Radionuclide scan has high sensitivity. All 3 phases positive
  2. Scintigraphy: Labeled WBC study. See if SBC goes to bone. More specific for osteomyelitis
  3. MRI is most sensitive AND specific. Detects changes early.
    - ->All of these help with differentiating between soft tissue versus bone involvement.
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14
Q

Should you treat empirically in osteomyelitis?

A

YES=can gram stain for treatment. Usually include S aureus coverage

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15
Q

Cultures of a patient with osteomyelitis show Staph aureus. What would you use to treat if the patient is allergic to penicillins?

A

Cefazolin, ceftriaxone, or clindamycin

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16
Q

What would you use to cover osteomyelitis with GNR on gram stain?

A

Ampicillin/Ceftriaxone/Cipro depending on sensitivity

17
Q

What would you use if the pt had pseudomonas osteomyelitis?

A

Aminoglycosides or quinolones

18
Q

How do you treat chronic osteomyelitis?

A
  1. MRI/CT
  2. Debridement of bone/soft tissue
  3. 4-6 weeks of Abx
19
Q

How do you treat osteomyelitis in a pt with vascular insufficiency?

A

Make sure to revascularie limbs and provide surgical debridement

20
Q

What other unusual organism do you have to worry about in a pt with osteomyelitis and a cough?

A

TB–Pott’s disease with granulomas forming in the bone