Professional Documents
Culture Documents
OSTEOMYELITIS
A. Etiology and Pathophysiology
Osteomyelitis is a severe infection of the bone, bone marrow, and surrounding soft tissue. Although Staphylococcus
aureus is a common cause of infection, a variety of microorganisms may cause osteomyelitis.
Category:
a. Exogenous or Direct entry
-Infectious microorganisms enter from outside the
body as in an open wound (e.g. penetrating wounds,
fractures)
- can also occur in the presence of an implant or an
orthopedic prosthetic device (e.g plate, total joint
prosthesis)
b. Endogenous or Indirect entry (hematogenous)
- Most common type osteomyelitis
- patient with vascular insufficiency disorders (e.g.,
diabetes mellitus) and genitourinary and respiratory
tract infections are at higher risk
- The pelvis, tibia, and vertebrae, which are vascularrich sites of bone= most common sites of infection.
Patho:
B. T
ypes,
Clini
cal
Man
ifest
ation
s
and
Com
plica
tions
1. Acute osteomyelitis refers to the initial infection or an
infection of less than 1 month in duration. The clinical manifestations of acute osteomyelitis are both local
and systemic.
Local manifestations:
constant bone pain
swelling
tenderness
warmth at the infection site
restricted movement of the affected part.
Systemic manifestations
Fever
**Older adults may not have an extreme temperature elevation because of lower core body temperature and
compromised immune system that occur with normal aging.
2. Chronic osteomyelitis longer than 1 month or an infection that has failed to respond to the initial course of
antibiotic therapy.
septicemia
septic arthritis
pathologic fractures
o
o
amyloidosis
Flexion contracture of the lower
extremity
C. Diagnostic Procedures
a. Bone or soft tissue biopsy- definitive way to determine the causative microorganism.
b. Radionuclide bone scans (gallium and indium) are helpful in diagnosis and are usually positive in the area
of infection.
c. CBC and wound culture with elevated WBC count and erythrocyte sedimentation rate (ESR).
d. X-ray signs usually do not appear until 10 days to weeks after the initial clinical symptoms
e. Magnetic resonance imaging (MRI) and computed tomography (CT) scans may be used to help identify
the extent of the infection.
D. Drug-related Therapy
a. IV antibiotic therapy is the treatment of choice; Vigorous and prolonged(to be effective)
**Teach family members or other caregivers in the home setting how to administer antimicrobials if they
are continued after hospital discharge or are used only at home.
b. For adults, therapy with a fluoroquinolone (ciprofloxacin [Cipro]) for 6 to 8 weeks may be prescribed instead
of IV antibiotics.
c. Oral antibiotic therapy may also be given after acute IV therapy
d. Nonsteroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, and muscle relaxants may be prescribed
to provide patient comfort.
e. Hyperbaric oxygen (HBO) therapy- the affected area is exposed to a high concentration of oxygen that
diffuses into the tissues to promote healing.
f. Negative-pressure wound therapy (vacuum-assisted wound closure)- for wound
E. Surgical Management