Y2S1B1
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| Most common microbes that cause osteomyelitis | staph aureus, (90% of acute peds cases) coagulase-negative staph
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| Less common microbes causing osteomyelitis | strep, enterococcus, e. coli, serratia sp, anaerobes
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| Rare microbes causing osteomyelitis | mycobacterium, dimorphic fungi, candida sp, asperigillus, mycoplasma, brucella, salmonella, actinomyces
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| Gram positive cocci | staph, strep, enterococcus
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| Gram negative cocci | neisseria (gonorrhoeae, meningitidis), moraxella, acinetobacter
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| Gram positive bacilli - Endospore formers | bacillus, clostridium
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| Gram positive bacilli - Non-endospore formers: regular shape/stain | Listeria, erysipelothrix
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| Gram positive bacilli - Non-endospore formers: Irregular shape/stain - acid fast | 1. Non-acid fast - corynabacterium, ropionobacterium; 2. Actinomycetes - actinomyces, nocardia
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| Gram negative bacilli - aerobes | Bordetella, Brucella, Francisella, Pseudomonas
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| Gram negative bacilli - obligate anaerobes | Bacteroides
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| Gram negative bacilli - facultative anaerobes: lactose fermenting | Citrobacter, Enterobacter, Escherechia, Klebsiella
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| Gram negative bacilli - facultative anaerobes: non-lactose fermenting - oxidase negative | Salmonella, Shigella, Yersenia, Serretia, Proteus Morganella
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| Gram negative bacilli - facultative anaerobes: non-lactose fermenting - oxidase positive | Haemophilus, Pasteruella
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| Clinical presentation of osteomyelitis | localized pain, fever, tenderness to palpation over affected site; hematogenous spread; conitguous focus of infxn; draining sinus tract; X-ray bone erosion and subperiosteal bone deposition
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| Diagnostic approach for osteomyelitis | blood culture (ID the bug); MRI for sinus tract; stain/culture aspirate/biopsy; x-ray - after 1wk shows new periosteal bone, metaphaseal bone destruction; If there's diagnostic doubt order a bone scan
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| Managing acute osteomyelitis | bacterial microbials, surgical drainage if necessary
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| Managing chronic osteomyelitis | long term high dose antibiotics; surgical removal of sequestrum/necrotic tissue/bone abscess
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| Antimicrobial therapy in osteomyelitis | 1. b-lactams and vancomycin; 2. cephalosporins, penicillinase-resistant penicillins
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| Osteomyelitis in contaminated open fx (3-25% of fx) | Staph and aerobic G- bacilli
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| Vertebral osteomyelitis, spondylodiskitis, epidural abscess | hematogenous spread; S. aureus and coag-neg Staph; M. tubercuolsis and Brucella (endemic); G- aerobic and Candida (IVDA, immunosupp, post-op)
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| Acute Hematogenous Osteomyelitis | long bones (tib/fib); S. aureus, Strep. pneumoniae, H. influenzae; kids, elderly, IVDA, catheters
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