Osteomyelitis and Septic Arthritis 2018

Question 1

Bacterial causes of osteomyelitis

Answer 1

Staph aureus
Kingella kingae (more so in children ages 2-5)
Strep pneumo
Strep pyogenes
Salmonella (people with sickle cell)

Question 2

Where is the most common site of osteomyelitis infections?

Answer 2

Metaphysis in the long bones

Question 3

Clinical manifestations of osteomyelitis

Answer 3

Pain
Fever may be present
Localized swelling or fluctuance and erythema if there is an abscess

Question 4

Clinical manifestations of septic arthritis

Answer 4

Specific swelling of the joint
Joint effusion
Pain with movement

Question 5

Labs and imaging to do for osteomyelitis

Answer 5

WBC is usually elevated by not always
CRP (better than ESR)
X-ray
MRI is best test (bone marrow edema)

Question 6

Signs of osteomyelitis on x-ray and when they appear

Answer 6

Lytic lesions
Periosteal lifting
They occur 7-21 days after the onset of infection

Question 7

First line treatment for acute osteomyelitis or septic arthritis

Answer 7

Cefazolin
Vancomycin can be added for MRSA if risk factors
Cefuroxime could be added to cover H flu for children under 4 who are unimmunized or living in an area where H flu is more common

Question 8

Criteria to transfer from IV to PO treatment for osteomyelitis

Answer 8

Afebrile
Able to weight bear (lower limb)
Mild pain with routine use (upper limb)

Question 9

Duration of treatment for acute osteomyelitis

Answer 9

Between 21 and 28 days if uncomplicated

Question 10

Duration of treatment for septic arthritis

Answer 10

3 to 4 weeks

4-6 weeks if the hip is involved

Question 11

When can you stop antibiotics for AO or SA?

Answer 11

Clinical resolution of symptoms

Normal CRP