352 osteomyelitis
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37 terms
Terms | Definitions |
|---|---|
 what are signs and symptoms of osteomyelitis? | fever, pain, redness, swelling, limping or other loss of function, tenderness over affected bone |
| what is the gold standard for diagnosis of osteomyelitis? | bone scan. diagnosis can be seen 1 day after onset of symptoms |
| what parts of the body are often affected in hematogenous osteomyelitis? | long bones and joints. vertebrae may be affected in adults >50 years old |
| what is the most common of source of osteomyelitis infection? | hematogenous |
| can xray be used to diagnose osteomyelitis? | not particularly useful. Lags 10-14 days |
| what is the contiguous source of osteomyelitis infection? | spreads to bone from adjacent site of infection |
| what are the most common bones affected in contiguous osteomyelitis? | femur, tibia, mandible |
| in what population is contiguous osteomyelitis most common? | 50 years plus |
| what is the vascular insufficiency source of osteomyelitis infection? | from poor perfusion or circulation to the area |
| in what population is vascular insufficiency source of osteomyelitis infection most common? | adults > 50 years old, diabetics (but not always related to diabetes) |
| what area of the body is most commonly affected by vascular insufficiency osteomyelitis? | bones in feet and toes |
| what are risk factors for poor outcome in osteomyelitis? | inadequate intitial debridement, prosthetic material (hip and knee replacements), duration of infection (>48 hrs before initiation of therapy), or previous tx failure |
| within what period of time should antibiotics be administered to improve outcomes in osteomyelitis? | 48 hours |
| what is the duration of treatment for osteomyelitis? | 4-6 weeks |
| what are the most common pathogens for hematogenous osteomyelitis in neonates? | group b strep, gram negative enterics, staph aureus |
| what is the empiric treatment for a neonate with hematogenous osteomyelitis? (assume no possibility of MRSA) | cloxacillin and cefotaxime |
| what are the most common pathogens for hematogenous osteomyelitis in children? | staph aureus, group a strep (rare: h. influenza, s pneumoniae, gram - enterics) |
| what is the empiric treatment for a child with hematogenous osteomyelitis? (assume no possibility of MRSA) | cloxacillin (add cefotaxime if not immunized against h. influenza) |
| what is the empiric treatment for a neonate with hematogenous osteomyelitis in which MRSA is possible? | vancomycin + cefotaxime |
| what are the most common pathogens for adults with hematogenous osteomyelitis? | staph aureus. (rare: gram - enterics) |
| what is the empiric treatment for an adult patient with hematogenous osteomyelitis? assume MRSA is not likely | cloxacillin or cefazolin |
| what is empiric treatment for contiguous osteomyelitis from a head/neck source? | clindamycin +/- gentamicin |
| what is empiric treatment for contiguous osteomyelitis from a soft tissue source? | cloxacillin or cefazolin |
| what is empiric treatment for contiguous osteomyelitis from a penetrating trauma in a child? | cloxacillin + ceftazafime +gentamicin |
| what is empiric treatment for contiguous osteomyelitis from a penetrating trauma in an adult? | fluoroquinolones |
| what are the usual pathogens in a penetrating trauma osteomyelitis? | pseudomonas, staph aureus |
| what are the usual pathogens that cause vascular insufficiency osteomyelitis? | staph aureus, streptococci, gram negative bacilli, anaerobes, polymicrobial infection |
| what is the empiric treatment for a patient with contiguous osteomyelitis caused by a diabetic foot ulcer? assume there is no MRSA | carbapenem, pip/tazo, fluroquinolone +/- clindamycin or metro |
| what dose and regimen should be used for osteomyelitis caused by MSSA? | cloxacillin 2g IV q4-6h, cefazolin 2g IV q8h, clindamycin 600mg IV q8h |
| what dose and regimen should be used for osteomyelitis caused by MRSA? | Vancomycin 1g IV q8-12h +/- rifampin 600mg PO qd |
| what dose and regimen should be used for osteomyelitis caused by group A or B strep? | Penicillin G 4 million units IV q4h |
| what dose and regimen should be used for osteomyelitis caused by enteric gram negative bacilli? | Cefotaxime 2g IV q8h |
| what dose and regimen should be used for osteomyelitis caused by pseudomonas? | Ceftazidime 2g IV q8h + gentamicin 1-2.5mg/kg IV q8h |
| what dose and regimen should be used for osteomyelitis caused by mixed aerobic and anaerobic bacteria? | Imipenem 500mg IV q6h, Pip/tazo 4.5g IV q6h |
| when is it acceptable to step down to oral osteomyelitis therapy? | patient is sysmtemically better, afebrile, and local signs of inflammation and tenderness have improved/resolved |
| in what circumstances is it not appropriate to step down from IV to oral osteomyelitis therapy? | neonates, immunocomp, will not attend follow up appointments, MRSA resistant to clindamycin, poor adherence, recurrent or chronic osteomyelitis |
| what is the standard duration of therapy for osteomyelitis? | 4-6 weeks |
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