Osteomyelitis

Vital signs

Ainur
Abdrakhmanova
 Vital signs
Awake Sleeping
Age
Rate Rate Respiratory
Age
Rate
Neonate (<28 d) 100-205 90-160
Infants (<1 y) 30-53
Infant (1 mo-1 y) 100-190 90-160
Toddler (1-2 y) 22-37
Toddler (1-2 y) 98-140 80-120
Preschool (3-5 20-28
Preschool (3-5 y) 80-120 65-100
y)
School-age (6-11 y) 75-118 58-90
School-age (6- 18-25
Adolescent (12-15 60-100 50-90 11 y)
y)
Adolescent (12- 12-20
Age Systolic BP Diastolic BP
15 y)
Birth (12 h) 60-76 31-45
Neonate (96 h) 67-84 35-53
Age: 7 y.o
Infant (1-12 mo) 72-104 37-56 BP: 84/42
Toddler (1-2 y) 86-106 42-63 HR: 134
Preschooler (3-5 y) 89-112 46-72
School-age (6-9 y) 97-115 57-76
Preadolescent (10-11 102-120 61-80
y)
 Types

Hematogeno Contiguous Iatrogenic

us (local infection (joint
site) replacement,
(via bloodstream)
internal fixation of
Most common
trauma )
Etiolog
y
Acute Chronic
S. aureus (70% - S. aureus
90%)
S. P. aeruginosa
pneumonia
S. pyogenes S. Marcescens
e
(Gram negative,
Kingella rod)
kingae E.coli
(Gram
negative,
Aerobic,
coccobacilli)
Table 1. Age-specific etiologic agents of pediatric acute
osteomyelitis

Note. Reprinted from A case of acute osteomyelitis: an update on diagnosis and

treatment, by Chiapini E., Mastrangelo G., Lazzeri S. 2016 May 25:13(539):1-10.
 Clinical features
Local erythema,
swelling, pain over
involved bone

Reluctance to use
affected extremity

Irritability, lethargy

Fever
 Pathogenesis
Nutrient Slow blood
artery flow
Endothelial
Metaphysis gaps in the
vessels
No
phagocytes in
Anchor and Inflammation capillaries
obstruct blood
vessels

Impaired Bone
phagocytosis destruction
and antibiotic
penetration
 Diagnosis
Symptoms and physical examination
ESR and C-reactive protein elevated
Blood culture (positive in one-half of cases)
Bone biopsy for culture
X-ray (detection when ~ 50% of bone lost)
MRI (good for early diagnosis (3-5 d), sensitivity
and specificity ~ 90%, not for pt. with surgical
hardware
 Treatment
Empiric
treatment
Nafcillin Vancomycin +/-
Clindamycin rifampin
1st generation Alternative: Linezolid
cephalosporin S. aureus
(cephalexin) S. pyogenes
S.
pneumoniae
- lactam

Kingella
Kingae
 Reference
Chiapini E., Mastrangelo G., Lazzeri S. A case of acute
osteomyelitis: an update on diagnosis and treatment. 2016 May
25:13(539):1-10.
Gutierres K. Bone and joint infections. Osteomyelitis. Retrieved
from https://
www.macpeds.com/documents/11LongChap78-osteomyelitis.pdf .
Hatzenbuehler J., Pulling T. J. Diagnosis and management of
osteomyelitis. American Academy of Family Physicians, 2011
November 1;84(9):1027-1033.
Kishner S. Osteomyelitis. Retrieved from http://
emedicine.medscape.com/article/1348767-overview
Pediatric vital signs. Retrieved from http
://www.emedicinehealth.com/pediatric_vital_signs/article_em .
htm