Osteomyelitis

Question 1

What 5 populations are at risk?

Answer 1

Children

Diabetics

IV drug users

sickle cell patients

immunosuppressed individuals

Question 2

2 Mechanisms of Bone Infections

Answer 2

1- Hematogenous Spread

- Kids (blood to long bones undergoing growth - distal femur, proximal tibia)
- Adults - pelvis and vertebral column

• Contiguous Spread (localized infection - outside structures –> deeper structures)
  
  • When open wound allows bacteria to penetrate to deeper tissues
  • Non-healing foot wounds w/ DM or those w/ poor circulation
  • Seen in open fractures that penetrate skin
  • Puncture wounds - foreign object in skin

Question 3

3 Common Pathogens

Answer 3

• Staph aureus (skin bacteria) - IV drugs, open fracture, open wounds
  
  • Less common enterobacter and strep A and B
• Salmonella - sickle cell
• Pseudo - puncture wound thru athletic shoes

Question 4

Dx

Answer 4

• Blood cx (look for bacteria in blood)
• Labs - CBC, inc WBCs, ESR, CRP (non-specific)
• Can do needle aspiration or biopsy for causative agent too
• Imaging - Xray, MRI, bone scan (dye goes to areas of inc blood flow - infection or malignancy)

Question 5

Tx

Answer 5

• Abx (choose by cx)
• Treat empirically for staph and strep while waiting for results
• Surgical debridement if severe