Chronic osteomyelitis
From IDWiki
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 species
- Enterococcus species
- 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