Chronic osteomyelitis: Difference between revisions
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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 |
| + | ** There is no evidence that antibiotic therapy longer than 4 to 6 weeks improves outcomes<ref>Brad Spellberg , Benjamin A. Lipsky, Systemic Antibiotic Therapy for Chronic Osteomyelitis in Adults, ''Clinical Infectious Diseases'', Volume 54, Issue 3, 1 February 2012, Pages 393–407, https://doi.org/10.1093/cid/cir842</ref> |
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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 09:48, 16 August 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
- 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
- ↑ Brad Spellberg , Benjamin A. Lipsky, Systemic Antibiotic Therapy for Chronic Osteomyelitis in Adults, Clinical Infectious Diseases, Volume 54, Issue 3, 1 February 2012, Pages 393–407, https://doi.org/10.1093/cid/cir842
