Osteomyelitis
para>Medullary osteomyelitis (stage 1) in children may be treated without surgical intervention (2)[B].
INPATIENT CONSIDERATIONS
Admission Criteria/Initial Stabilization
Correct electrolyte imbalances, hyperglycemia, azotemia, and acidosis; control pain.
Nursing
Bed rest and immobilization of the involved bone and/or joint
Discharge Criteria
Clinical and laboratory evidence of resolving infection and appropriate outpatient therapy
ONGOING CARE
FOLLOW-UP RECOMMENDATIONS
Patient Monitoring
Blood levels of antimicrobial agents, ESR, CRP, and repeat plain radiography as clinical course dictates
PATIENT EDUCATION
Diabetic glycemic control and foot care
PROGNOSIS
- Superficial and medullary osteomyelitis treated with antimicrobial and surgical therapy have a response rate of 90 " 100%.
- Up to 36% recurrence rate in diabetics
- Increased mortality after amputation
COMPLICATIONS
- Abscess formation
- Bacteremia
- Fracture/nonunion
- Loosening of prosthetic implant
- Postoperative infection
- Sinus tract formation can be associated with neoplasms, especially in presence of long-standing infection.
REFERENCES
11 Malhotra R, Chan CS, Nather A. Osteomyelitis in the diabetic foot. Diabet Foot Ankle. 2014;5. doi:10.3402/dfa.v5.24445.22 Howard-Jones AR, Isaacs D. Systematic review of duration and choice of systemic antibiotic therapy for acute haematogenous bacterial osteomyelitis in children. J Paediatr Child Health. 2013;49(9):760 " 768.
ADDITIONAL READING
- Bhavan KP, Marschall J, Olsen MA, et al. The epidemiology of hematogenous vertebral osteomyelitis: a cohort study in a tertiary care hospital. BMC Infect Dis. 2010;10:158.
- Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis. 2008;47(4):519 " 527.
- Fraimow HS. Systemic antimicrobial therapy in osteomyelitis. Semin Plast Surg. 2009;23(2):90 " 99.
- Stumpe KD, Strobel K. Osteomyelitis and arthritis. Semin Nucl Med. 2009;39(1):27 " 35.
- Vardakas KZ, Kontopidis I, Gkegkes ID, et al. Incidence, characteristics, and outcomes of patients with bone and joint infections due to community-associated methicillin-resistant Staphylococcus aureus: a systematic review. Eur J Clin Microbiol Infect Dis. 2013;32(6):711 " 721.
- Zimmerli W. Clinical practice. Vertebral osteomyelitis. N Engl J Med. 2010;362(11):1022 " 1029.
CODES
ICD10
- M86.9 Osteomyelitis, unspecified
- M86.00 Acute hematogenous osteomyelitis, unspecified site
- M86.10 Other acute osteomyelitis, unspecified site
- M86.8X5 Other osteomyelitis, thigh
- M86.50 Other chronic hematogenous osteomyelitis, unspecified site
- M86.60 Other chronic osteomyelitis, unspecified site
- M86.659 Other chronic osteomyelitis, unspecified thigh
- M86.8X9 Other osteomyelitis, unspecified sites
- M86.259 Subacute osteomyelitis, unspecified femur
ICD9
- 730.20 Unspecified osteomyelitis, site unspecified
- 730.00 Acute osteomyelitis, site unspecified
- 730.10 Chronic osteomyelitis, site unspecified
- 730.25 Unspecified osteomyelitis, pelvic region and thigh
- 730.26 Unspecified osteomyelitis, lower leg
SNOMED
- 60168000 Osteomyelitis (disorder)
- 409780002 Acute osteomyelitis (disorder)
- 40970001 Chronic osteomyelitis (disorder)
- 1551001 osteomyelitis of femur (disorder)
- 67322009 Subacute osteomyelitis (disorder)
CLINICAL PEARLS
- Hematogenous osteomyelitis is usually monomicrobial, whereas osteomyelitis due to contiguous spread or direct inoculation is usually polymicrobial.
- Acute osteomyelitis typically presents with gradual onset of pain.
- Treatment of osteomyelitis often requires both surgical debridement and at least 6 weeks of antimicrobial therapy.