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Good Morning It’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.
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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