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August 20, 2010

Osteomyelitis

1% of pediatric admissions Neonates*

Hematogenous spread* Tibia or femur

50% associated with septic joint* GBS & E.Coli

Older children* Staph aureus*, Group A Strep, HIB, Salmonella

(SCD) Rare joint involvement

Osteomyelitis

Direct invasion Spread from focus

Trauma Staph aureus

Puncture Pseudomonas

Sole of sneaker E. coli

Animal Bite Anaerobes Staph

Osteomyelitis

Hematogenous* Acute pain and decreased movement* Possible swelling or redness* Systemic Symptoms

Fever Malaise Irritability

Osteomyelitis

Following trauma Insidious, subacute onset Localized pain, edema and redness Absence of systemic symptoms

Chronic Local findings may be absent or intermittent Possible sinus tracts Absence of systemic symptoms

Osteomyelitis

Lab findings

Elevated or normal leukocyte

ESR/CRP elevated

Positive blood culture 50%

Osteomyelitis

Imaging Plain films

1-2 weeks* Edema of surrounding tissues Periosteal reaction New bone formation

2 weeks Lytic lesions

Osteomyelitis

Imaging* Bone Scan

2-3 days Unclear location Nonspecific

MRI Specific Abscess

Pelvic Osteomyelitis*

Stats Older children

Mean 8.1y Boys > Girls Ilium > ischium or pubis Right > left

Increased risk for abscess formation Late diagnosis Staph aureus

Osteomyelitis

Treatment* High dose

Bactericidal levels in bone 4-6 weeks

Staph or Strep Oxacillin or naficillin 1st or 2nd generation cephalosporins Clindamycin

HIB 2nd or 3rd generation cephalosporin

Osteomyelitis

Treatment

Sickle Cell 3rd generation cephalosporin

Other bugs to consider Pseudomonas, anaerobes, GBS and E. coli

Osteomyelitis

Complications

Recurrence 5-10% are chronic

Abscess