GOOD MORNINGIT’S FRIDAY!!!

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