Osteomyelitis Flashcards
What is Osteomyelitis?
Inflammation of the bone, often due to Infection.
Usually presents in long bones (especially the medullary cavity)
Can Recur after treatment
How can Osteomyelitis be categorised?
Time: Acute (<6 weeks) or Chronic (>6 weeks)
Spread: Haematogenous/Contiguous/Direct Inoculation
In which patients is Salmonella-Causative Osteomyelitis common in?
Sickle Cell Patients
N.B. Staph. Aureus is also common
What is a GENERAL clinical presentation of Osteomyelitis?
Localised Bone Pain
Malaise
Fever
Night Sweats
IF YOU CAN SEE A TENDON, IT IS OSTEOMYELITIS
What is a bone change characteristically seen in pyogenic osteomyelitis?
Involucrum
Results from the stripping-off of the periosteum from accumulation of pus within the bone and new bone growing from the periosteum
What are CLASSIC investigations done in Osteomyelitis?
Bone Biopsy
Bone Cultures (via Percutaneous Aspiration or Deep Bone)
MRI
How does Open Fracture Osteomyelitis present?
How does it occur?
Non-Union
Poor Wound Healing
Occurs due to Contiguous Spread of infection
What are common bugs in Open Fracture Osteomyelitis?
Staph. Aureus
Aerobic Gram Negatives
What is treatment for Open Fracture Osteomyelitis?
Aggressive Surgical Debridement to remove infected tissue and pus
Fixation
Soft Tissue Cover: IV Co-Amoxiclav and Metronidazole
How does Diabetic Venous Insufficiency Osteomyelitis occur?
Contiguous Spread
What are common bugs for Diabetic Venous Insufficiency Osteomyelitis?
Often Polymicrobial!
Staph. Aureus most common
Gram Negatives
What are Signs for Diabetic Venous Insufficiency Osteomyelitis?
Chronic/Indolent/Deep Ulcer
WILL GET INFECTION IF WOUND IS >2cm FOR >2 MONTHS
Positive Probe-to-Bone Test
High Inflammatory Marker Levels
What is treatment for Diabetic Venous Insufficiency Osteomyelitis?
Surgical Debridement
Antimicrobials
What antibiotics are used in Diabetic Venous Insufficiency Osteomyelitis?
Mild: Flucloxacillin (if penicillin allergy, Vancomycin)
Moderate: Oral Flucloxacillin + Metronidazole
Severe: IV Flucloxacillin, Gentamycin
How long should antibiotics be given in Diabetic Venous Insufficiency Osteomyelitis?
7 Day: SSTIs
14 day: Bacteremia
6 weeks: Osteomyelitis (2 weeks IV, 4 weeks Oral)
Consider this for other forms of Osteomyelitis too
In which patients is Haematogenous Osteomyelitis more common?
IV Drug Users
Prepubertal Children
Central Lines/Dialysis Patients
Elderly
What are COMMON bugs in IV Drug User Haematogenous Osteomyelitis?
Staph. Aureus
Streptococci
What are UNUSUAL bugs in IV Drug User Haematogenous Osteomyelitis?
Pseudomonas
Candida
Mycobacterium TB
Eikenella Corrodens (needle lickers)
What will characteristic of IV Drug User Osteomyelitis?
Osteomyelitis in unusual sites e.g. Sternoclavicular Joint, Sacroiliac Joint, Pubic Symphysis etc.
What are common bugs in Central Line/Dialysis Patient Osteomyelitis?
Staph. Aureus
Aerobic Gram Negatives
What is treatment for Haematogenous Osteomyelitis?
14 days Antibiotics
Wait for lab results UNLESS THERE IS SEPSIS RISK, then start from day 1 of positive culture
What factors need to be considered with Aseptic Osteitis Pubis?
Triggered by surgery
Presentation can be up to 18 months later
Athletes can get it
What are potential causers of Clavicular Osteomyelitis?
Neck surgery
Subclavian vein catheterisation
Vertebral Osteomyelitis is mostly Haematogenous. True/False?
True.
What are associations of Vertebral Osteomyelitis?
Psoas/Epidural Abscess IV Drug Use Infection (IV Sites/GU Tract/SSTI/Post Operative) Diabetes Immunosuppression
What are symptoms of Vertebral Osteomyelitis?
Systemic Upset e.g. Fever etc. Insidious Back Pain/Tenderness Neurological Symptoms Raised Inflammatory Markers Paraspinal Muscle Spasm
What are investigations of Vertebral Osteomyelitis?
MRI
FBC
Biopsy (consider open biopsy is first 2 do not show much)
What is treatment of Vertebral Osteomyelitis?
Surgical Drainage of Abscess
Antimicrobials for 6 Weeks
extend duration in complex cases
Antibiotics should be given in all osteomyelitis presentations. True/False?
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
