Chronic osteomyelitis: Difference between revisions
From IDWiki
No edit summary |
mNo edit summary |
||
| (One intermediate revision by the same user not shown) | |||
| Line 18: | Line 18: | ||
== Investigations == |
== Investigations == |
||
* CT is better than MRI for imaging for bony sequestrum |
* CT is better than MRI for imaging for bony sequestrum[[CiteRef::bickle2009bo]] |
||
==Management== |
==Management== |
||
* Ideally get bone biopsy for culture prior to starting antibiotics |
* 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 |
* 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 |
||
** [[TMP-SMX]] or a fluoroquinolone is preferred oral |
** [[TMP-SMX]] or a fluoroquinolone is preferred oral therapy |
||
** There is no evidence that antibiotic therapy longer than 4 to 6 weeks improves outcomes[[CiteRef::spellberg2011sy]] |
|||
* Some recommend adding [[rifampin]] for ''[[Staphylococcus aureus]]'', especially if hardware is involved |
* Some recommend adding [[rifampin]] for ''[[Staphylococcus aureus]]'', especially if hardware is involved |
||
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.
