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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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osteomyelitis
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
osteomyelitis1
Osteomyelitis
  • Direct invasion
  • Spread from focus
    • Trauma
      • Staph aureus
    • Puncture
      • Pseudomonas
        • Sole of sneaker
      • E. coli
    • Animal Bite
      • Anaerobes
      • Staph
osteomyelitis2
Osteomyelitis
  • Hematogenous*
    • Acute pain and decreased movement*
    • Possible swelling or redness*
    • Systemic Symptoms
      • Fever
      • Malaise
      • Irritability
osteomyelitis3
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
osteomyelitis4
Osteomyelitis
  • Lab findings
    • Elevated or normal leukocyte
    • ESR/CRP elevated
    • Positive blood culture
      • 50%
osteomyelitis5
Osteomyelitis
  • Imaging
    • Plain films
      • 1-2 weeks*
        • Edema of surrounding tissues
        • Periosteal reaction
        • New bone formation
      • 2 weeks
        • Lytic lesions
osteomyelitis6
Osteomyelitis
  • Imaging*
    • Bone Scan
      • 2-3 days
      • Unclear location
      • Nonspecific
    • MRI
      • Specific
      • Abscess
pelvic osteomyelitis
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
osteomyelitis7
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
osteomyelitis8
Osteomyelitis
  • Treatment
    • Sickle Cell
      • 3rd generation cephalosporin
    • Other bugs to consider
      • Pseudomonas, anaerobes, GBS and E. coli
osteomyelitis9
Osteomyelitis
  • Complications
    • Recurrence
      • 5-10% are chronic
    • Abscess