Bone and Joint Infections

What does it mean for a patient to have hematogenous osteomyelitis?

Bone infection caused by bacteremia

What does it mean for a patient to have contiguous osteomyelitis

Bone infection caused by spread from adjacent tissues

What area is infected with osteomyelitis?

Shaft of the bone

How common is osteomyelitis (compared to infectious arthritis)?

uncommon

What is the most common type/origin of osteomyelitis?

Contiguous

What is the most common clinical presentation of osteomyelitis?

pain and tenderness of infected area

What area is infected in infectious arthritis?

Joint

How common is infectious arthritis (compared to osteomyelitis)?

common

What is the most common origin of septic arthritis?

hematogenous

What is the most common clinical presentation of septic arthritis?

Immobility of joint, no point of tenderness

Which bones are typically affected by osteomyelitis in persons

Long bones

Which bones are typically affected by osteomyelitis in patients >50yo with diabetes, trauma, or a UTI?

Vertebral bones

Which bones are typically affected by osteomyelitis in patients >50yo with a hip fracture or an open fracture?

Femur, tibia, mandible

Which bones are typically affected by osteomyelitis in patients >50yo with diabetes or PVD?

feet, toes

What organisms are typically to blame for acute hematogenous osteomyelitis?

Staphylococcus aureus, Streptococci, Gram negative rods

What organisms are typically to blame for contiguous osteomyelitis?

S. aureus, Streptococcus, S. epidermidis, Gram negative rods, anaerobes

What is the definition of chronic osteomyelitis?

Clinical signs for >30 days, open bone injury, necrotic bone

What organisms are typically to blame for chronic osteomyelitis?

S. aureus, S. epidermidis, P. aeruginosa, E. coli, S. marcescens

What is the best way to diagnose osteomyelitis?

MRI

Which bugs most commonly cause osteomyelitis in infants

Group B Streptococci, S. aureus, E. Coli

Which bugs most commonly cause osteomyelitis in children 1-5 yo?

S. aureus, Streptococcus pyogenes, Streptococcus pneumoniae, Kingella kingae

Which bugs most commonly cause osteomyelitis in children >5 yo?

S. aureus, Streptococcus pyogenes

Which bugs most commonly cause osteomyelitis in Adults?

Staph epidermidis, S. aureus, P. aeruginosa, Serratia marcescens, E. Coli

When are anaerobic bacteria most likely to be the cause of osteomyelitis?

Patients with DM or who have been bitten

How long should patients with osteomyelitis be treated with ABX?

At least 6 weeks

(T/F) When treating osteomyelitis, you should always cover for MRSA empirically

True

Which ABX have good bone penetration?

Clindamycin, Tetracyclines, Quinolones, Linezolid, Trimethoprim

Which ABX have okay bone penetration at high doses?

Vancomycin, Beta lactams, Daptomycin

What are the options for empiric treatment of acute osteomyelitis in adults?

Vancomycin, Daptomycin

What are the options for empiric treatment of acute osteomyelitis in children?

Clindamycin, Vancomycin

What are the options for empiric treatment of acute osteomyelitis in adults with risk of pseudomonas (ie IVDU)

Vancomycin or Daptomycin PLUS Ceftazidime or Cefepime

In patients with MSSA associated osteomyelitis, what is the DoC?

Cefazolin

When is it appropriate to use Clindamycin as the empiric treatment for osteomyelitis in children?

Local clindamycin resistance

When is it appropriate to use Vancomycin as the empiric treatment for osteomyelitis in children?

Local clindamycin resistance >10%, pt unstable, pt has bacteremia, pt has intravascular infection

In what scenario should rifampin be used as an adjunct to treat osteomyelitis?

Prosthetic joint infections

(T/F) Rifampin can be used as monotherapy to treat bone and joint infections

False

(T/F) Rifampin should be initiated 5-7 days after initial antibiotic therapy

True

What is the dose of vancomycin for osteomyelitis in adults?

15mg/kg IV q12h

What is the dose of daptomycin for osteomyelitis?

6mg/kg IV QDay

What is the dose of vancomycin for osteomyelitis in children?

15mg/kg/dose IV q6h

What is the dose of clindamycin for osteomyelitis in children?

10-13 mg/kg/dose IV q6-8h

When is it appropriate to transition to oral therapy to treat osteomyelitis?

After ~2 weeks of IV therapy IF the infection is MODERATE

(This does not include MRSA)

What is the best way to diagnose septic arthritis?

Aspiration of joint fluid

Which organisms most often cause septic arthritis in neonates?

S. aureus, Streptococcus, gram negatives

Which organisms most often cause septic arthritis in Children

S. aureus, Streptococcus, Kingella kingae

Which organisms most often cause septic arthritis in adolescents and adults (18-30yo)?

S. aureus, Neisseria gonorrhoeae

Which organisms most often cause septic arthritis in the Elderly?

S. aureus, gram negatives, S. epidermidis

What is appropriate empiric therapy for septic arthritis in adults?

Vancomycin or Daptomycin +/- Ceftriaxone (add in pts 18-30)

What is appropriate empiric therapy for septic arthritis in pts who use IV drugs?

Vancomycin or Daptomycin PLUS Ceftazidime or Cefepime

What is appropriate treatment for septic arthritis in pts with confirmed gonococcoal septic arthritis?

Ceftriaxone 2g Qday

How long should pts be treated with ABX for septic arthritis?

3-4 weeks