What is osteomyelitis?
Inflammatory condition of the bone caused by an infective organism
Most commonly stap. aureus. except in sudden cardiac arrest patients, salmonella species is more common
What are the two classifications of osteomyelitis?
Haematogenous osteomyelitis: Results from bacteraemia and usually monomicrobial → most common in children
Non-haematogenous osteomyelitis: Results from contagious spread of infection from adjacent soft tissues to the bone or from direct injury/trauma to the bone and usually polymicrobial
RF of haematogenous osteomyelitis
- Sickle cell anaemia
- IV drug use
- Immunosuppression
- Infective endocarditis
RF of non-haematogenous osteomyelitis
- Diabetic foot ulcers/pressure sores
- DM
- Peripheral arterial disease
which 2 types is most common in adults
Non-haematogenous osteomyelitis
How many bones does osteomyelitis usually involve?
A single bone
Part of the bone that it affects:
- Children → metaphysis
- Adults → epiphysis
RF
- Penetrating injury
- IV drug use
- Diabetes
- HIV
- Recent surgery
- Distant or local infection
CF
- Limp or reluctancy to weight bear mostly in children
- Pain at site of infection
- Malaise, fatigue, fever, chills
- Inflammation, tenderness, erythema or swelling
What is the most definitive imaging modality for osteomyelitis?
Bone MRI
What investigation is needed before giving Abx?
Bone biopsy
What will be raised in bloods?
- WCC
- ESR
- CRP
What is the management for osteomyelitis?
Abx therapy for 2-4 weeks → Flucloxacillin (IV)
allergic then use clindamycin
Complications
- Drug reactions
- Infection recurrence
- Fracture
Describe the prognosis if osteomyelitis is diagnosed promptly and treated adequately
For most patients with acute osteomyelitis recover with no long-term complications
