Chronic osteomyelitis: Difference between revisions
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* ''[[Staphylococcus aureus]]'' |
* ''[[Staphylococcus aureus]]'' |
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* [[Coagulase-negative staphylococci]] |
* [[Coagulase-negative staphylococci]] |
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* [[Streptococcus |
* [[Streptococcus]] |
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* [[Enterococcus |
* [[Enterococcus]] |
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* ''[[Pseudomonas aeruginosa]]'' |
* ''[[Pseudomonas aeruginosa]]'' |
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* Gram-negative [[Enterobacteriaceae]] |
* Gram-negative [[Enterobacteriaceae]] |
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** [[Non-tuberculous mycobacteria]] |
** [[Non-tuberculous mycobacteria]] |
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** Fungi |
** Fungi |
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== Investigations == |
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* CT is better than MRI for imaging for bony sequestrum[[CiteRef::bickle2009bo]] |
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==Management== |
==Management== |
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* Ideally get bone biopsy for culture prior to starting antibiotics |
* Ideally get bone biopsy for culture prior to starting antibiotics |
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* In general, typically treated with 4 to 6 weeks of parenteral or highly bioavailable therapy followed by step-down to oral therapy to complete total of 4 to 12 weeks |
* In general, typically treated with 4 to 6 weeks of parenteral or highly bioavailable therapy followed by step-down to oral therapy to complete total of 4 to 12 weeks |
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** [[TMP-SMX]] or a fluoroquinolone is preferred oral |
** [[TMP-SMX]] or a fluoroquinolone is preferred oral therapy |
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** There is no evidence that antibiotic therapy longer than 4 to 6 weeks improves outcomes[[CiteRef::spellberg2011sy]] |
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* Some recommend adding [[rifampin]] for ''[[Staphylococcus aureus]]'', especially if hardware is involved |
* Some recommend adding [[rifampin]] for ''[[Staphylococcus aureus]]'', especially if hardware is involved |
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Latest revision as of 17:27, 19 September 2024
Background
- Osteomyelitis that involves necrotic bone, usually suggested by treatment failure, symptoms lasting three or more weeks, presence of sequestrum, persistent drainage, or sinus tract
Microbiology
- Staphylococcus aureus
- Coagulase-negative staphylococci
- Streptococcus
- Enterococcus
- Pseudomonas aeruginosa
- Gram-negative Enterobacteriaceae
- Anaerobes including Cutibacterium acnes
- Unusual pathogens:
- After animal bite: Pasteurella multocida, Eikenella corrodens
- If risk factors: tuberculosis
- Non-tuberculous mycobacteria
- Fungi
Investigations
- CT is better than MRI for imaging for bony sequestrum1
Management
- Ideally get bone biopsy for culture prior to starting antibiotics
- In general, typically treated with 4 to 6 weeks of parenteral or highly bioavailable therapy followed by step-down to oral therapy to complete total of 4 to 12 weeks
- Some recommend adding rifampin for Staphylococcus aureus, especially if hardware is involved
References
- ^ bickle2009bo
- ^ B. Spellberg, B. A. Lipsky. Systemic Antibiotic Therapy for Chronic Osteomyelitis in Adults. Clinical Infectious Diseases. 2011;54(3):393-407. doi:10.1093/cid/cir842.
