Wk 12 osteomyelitis Fong

What is osteomyelitis?

Inflammation of bone cause by infection organisms (mono microbial > poly microbial)

What are risk factors for osteomyelitis?

Diabetes, recent injury, orthopedic surgery, IV drug use, dialysis, catheter use, immunosuppression, increase in gram + bacteremia risk

What bacteria cause osteomyelitis?

Staph aureus, streptococcus, GNR (contiguous > hematogenous)

What is hematogenous osteomyelitis?

Infection due to bloodstream (effects spine)

What is contiguous osteomyelitis?

Direct inoculation d/t trauma or surgery (effect hands/ feet)

What is diabetes osteomyelitis?

Infection due to diabetic vascular insufficiency (effects feet)

What is the clinical presentation of osteomyelitis?

Slow process, mild pain

What diagnostic tools are used for Osteomyelitis?

CT scan and MRI. Inflammation labs (CRP & ESR) not helpful in diagnostic, but good in monitoring

What cultures are used in osteomyelitis?

Bone biopsy (gold standard), blood culture and wound cultures are ok. Hold antibiotics until culture obtained

What Is source control in osteomyelitis?

Eliminated dead one (difficult in spine). Debridement until down to living bone. Last resort is amputation.

What is empiric therapy in osteomyelitis?

Vancomycin + ceftriaxone

What is the treatment duration for osteomyelitis?

acute 4-6 weeks, subacute/chronic ≥ 6 weeks

What is the treatment for osteomyelitis with hardware?

Rifampin 450mg IV/PO BID, remove hardware if possible

What is septic arthritis?

Infection of joint

What are risk factors for septic arthritis?

Rheumatoid or osteoarthritis, joint prosthesis, intra-articular corticosteroid use, alcoholism, diabetes, SSTI, IV drug use

What are symptoms for septic arthritis?

1-2 weeks of restricted joint movement, erythema, hot joint, fever, pain. Get synovial (joint) fluid aspirate before antibiotics unless hemodynamically unstable

What is empiric therapy for septic arthritis?

Vancomycin or Linezolid or Daptomycin + if sexually active Ceftriaxone

What is the duration of treatment for septic arthritis?

2 weeks IV therapy then 2 weeks oral therapy

What is the empiric treatment for diabetic foot infection?

Vancomycin + ceftriaxone or ciprofloxacin + Metronidazole