Chronic osteomyelitis: Difference between revisions
From IDWiki
(Created page with "==Background== * Osteomyelitis that involves necrotic bone, usually suggested by treatment failure, symptoms lasting three or more weeks, presence of sequestrum, persistent dr...") |
m (Text replacement - " species]]" to "]]") |
||
| Line 5: | Line 5: | ||
* ''[[Staphylococcus aureus]]'' |
* ''[[Staphylococcus aureus]]'' |
||
* [[Coagulase-negative staphylococci]] |
* [[Coagulase-negative staphylococci]] |
||
| − | * [[Streptococcus |
+ | * [[Streptococcus]] |
| − | * [[Enterococcus |
+ | * [[Enterococcus]] |
* ''[[Pseudomonas aeruginosa]]'' |
* ''[[Pseudomonas aeruginosa]]'' |
||
* Gram-negative [[Enterobacteriaceae]] |
* Gram-negative [[Enterobacteriaceae]] |
||
Revision as of 12:28, 28 January 2022
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
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
- TMP-SMX or a fluoroquinolone is preferred oral thereapy
- Some recommend adding rifampin for Staphylococcus aureus, especially if hardware is involved
