Chronic osteomyelitis: Difference between revisions
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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<ref>Gaillard F, Bell D, Knipe H, et al. Bony sequestrum. Reference article, Radiopaedia.org (Accessed on 16 Jan 2023) doi: [https://doi.org/10.53347/rID-7664 10.53347/rID-7664]</ref> |
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==Management== |
==Management== |
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Revision as of 16:54, 16 January 2023
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 sequestrum[1]
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
- ↑ Gaillard F, Bell D, Knipe H, et al. Bony sequestrum. Reference article, Radiopaedia.org (Accessed on 16 Jan 2023) doi: 10.53347/rID-7664
