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2MB Extra Material > Osteomyelitis > Flashcards

Osteomyelitis Flashcards

1
Q

What is Osteomyelitis?

A

Inflammation of the bone, often due to Infection.

Usually presents in long bones (especially the medullary cavity)

Can Recur after treatment

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2
Q

How can Osteomyelitis be categorised?

A

Time: Acute (<6 weeks) or Chronic (>6 weeks)

Spread: Haematogenous/Contiguous/Direct Inoculation

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3
Q

In which patients is Salmonella-Causative Osteomyelitis common in?

A

Sickle Cell Patients

N.B. Staph. Aureus is also common

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4
Q

What is a GENERAL clinical presentation of Osteomyelitis?

A

Localised Bone Pain
Malaise
Fever
Night Sweats

IF YOU CAN SEE A TENDON, IT IS OSTEOMYELITIS

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5
Q

What is a bone change characteristically seen in pyogenic osteomyelitis?

A

Involucrum

Results from the stripping-off of the periosteum from accumulation of pus within the bone and new bone growing from the periosteum

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6
Q

What are CLASSIC investigations done in Osteomyelitis?

A

Bone Biopsy

Bone Cultures (via Percutaneous Aspiration or Deep Bone)

MRI

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7
Q

How does Open Fracture Osteomyelitis present?

How does it occur?

A

Non-Union
Poor Wound Healing

Occurs due to Contiguous Spread of infection

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8
Q

What are common bugs in Open Fracture Osteomyelitis?

A

Staph. Aureus

Aerobic Gram Negatives

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9
Q

What is treatment for Open Fracture Osteomyelitis?

A

Aggressive Surgical Debridement to remove infected tissue and pus

Fixation

Soft Tissue Cover: IV Co-Amoxiclav and Metronidazole

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10
Q

How does Diabetic Venous Insufficiency Osteomyelitis occur?

A

Contiguous Spread

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11
Q

What are common bugs for Diabetic Venous Insufficiency Osteomyelitis?

A

Often Polymicrobial!

Staph. Aureus most common
Gram Negatives

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12
Q

What are Signs for Diabetic Venous Insufficiency Osteomyelitis?

A

Chronic/Indolent/Deep Ulcer
WILL GET INFECTION IF WOUND IS >2cm FOR >2 MONTHS

Positive Probe-to-Bone Test

High Inflammatory Marker Levels

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13
Q

What is treatment for Diabetic Venous Insufficiency Osteomyelitis?

A

Surgical Debridement

Antimicrobials

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14
Q

What antibiotics are used in Diabetic Venous Insufficiency Osteomyelitis?

A

Mild: Flucloxacillin (if penicillin allergy, Vancomycin)

Moderate: Oral Flucloxacillin + Metronidazole

Severe: IV Flucloxacillin, Gentamycin

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15
Q

How long should antibiotics be given in Diabetic Venous Insufficiency Osteomyelitis?

A

7 Day: SSTIs
14 day: Bacteremia
6 weeks: Osteomyelitis (2 weeks IV, 4 weeks Oral)

Consider this for other forms of Osteomyelitis too

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16
Q

In which patients is Haematogenous Osteomyelitis more common?

A

IV Drug Users
Prepubertal Children
Central Lines/Dialysis Patients
Elderly

17
Q

What are COMMON bugs in IV Drug User Haematogenous Osteomyelitis?

A

Staph. Aureus

Streptococci

18
Q

What are UNUSUAL bugs in IV Drug User Haematogenous Osteomyelitis?

A

Pseudomonas
Candida
Mycobacterium TB
Eikenella Corrodens (needle lickers)

19
Q

What will characteristic of IV Drug User Osteomyelitis?

A

Osteomyelitis in unusual sites e.g. Sternoclavicular Joint, Sacroiliac Joint, Pubic Symphysis etc.

20
Q

What are common bugs in Central Line/Dialysis Patient Osteomyelitis?

A

Staph. Aureus

Aerobic Gram Negatives

21
Q

What is treatment for Haematogenous Osteomyelitis?

A

14 days Antibiotics

Wait for lab results UNLESS THERE IS SEPSIS RISK, then start from day 1 of positive culture

22
Q

What factors need to be considered with Aseptic Osteitis Pubis?

A

Triggered by surgery

Presentation can be up to 18 months later

Athletes can get it

23
Q

What are potential causers of Clavicular Osteomyelitis?

A

Neck surgery

Subclavian vein catheterisation

24
Q

Vertebral Osteomyelitis is mostly Haematogenous. True/False?

A

True.

25
Q

What are associations of Vertebral Osteomyelitis?

A 
Psoas/Epidural Abscess 
IV Drug Use 
Infection (IV Sites/GU Tract/SSTI/Post Operative)
Diabetes 
Immunosuppression
26
Q

What are symptoms of Vertebral Osteomyelitis?

A 
Systemic Upset e.g. Fever etc.
Insidious Back Pain/Tenderness 
Neurological Symptoms 
Raised Inflammatory Markers 
Paraspinal Muscle Spasm
27
Q

What are investigations of Vertebral Osteomyelitis?

A

MRI

FBC

Biopsy (consider open biopsy is first 2 do not show much)

28
Q

What is treatment of Vertebral Osteomyelitis?

A

Surgical Drainage of Abscess

Antimicrobials for 6 Weeks
extend duration in complex cases

29
Q

Antibiotics should be given in all osteomyelitis presentations. True/False?

A

Tricky one, but true!
DO NOT USE EMPIRICAL ANTIBIOTICS!

In Acute Osteomyelitis, treat with IV Flucloxacillin + Gentamycin + Metronidazole

In Chronic Osteomyelitis, treat with Oral Flucloxacillin

2MB Extra Material (21 decks)

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