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Rangkuman Week 5 (PBL) - Osteomyelitis

The document outlines the key principles in the treatment of musculoskeletal infections like osteomyelitis. It discusses the common causative organisms, pathogenesis, clinical symptoms, and principles of antibacterial therapy. For antibacterial therapy, it provides a table listing the recommended antimicrobial agents for common organisms causing osteomyelitis, along with their typical dosing and comments. The primary goals of treatment are to eliminate the infection and minimize damage to the bone and surrounding tissues, often through a combination of bed rest, antibiotics administered for 4-6 weeks, and sometimes surgery to remove dead bone tissue.

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Maria Dini Admirati
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202 views9 pages

Rangkuman Week 5 (PBL) - Osteomyelitis

The document outlines the key principles in the treatment of musculoskeletal infections like osteomyelitis. It discusses the common causative organisms, pathogenesis, clinical symptoms, and principles of antibacterial therapy. For antibacterial therapy, it provides a table listing the recommended antimicrobial agents for common organisms causing osteomyelitis, along with their typical dosing and comments. The primary goals of treatment are to eliminate the infection and minimize damage to the bone and surrounding tissues, often through a combination of bed rest, antibiotics administered for 4-6 weeks, and sometimes surgery to remove dead bone tissue.

Uploaded by

Maria Dini Admirati
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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WEEK OBJECTIVE 5 (OSTEOMYELITIS)

1. Line out classification and features of various form


of musculoskeletal infection
*will be answered by Maggie later

2. Describe the pathological features of pyogenic and


granulomatous osteomyelitis
Systemic disease.
Symptoms: bone pain, fever, malaise, local swelling, dull continuous
back pain which increases on straining.
Risk factors: diabetes, hemodialysis, injected drugs, AIDS, etc.

Lee and Waldvogel classification:


Acute vs chronic
Hematogenous vs contigious
Presence of vascular insufficiency

Acute pyogenic osteomyelitis


Staphylococcus aureus (methicilin sensitive)
Eschericia coli neonates
Salmonella patient with sickle cell
-Infants: (di metaphysis, bisa menyebar ke epifisis dan joint capsule)
Infection cortical bones periosteum subperiotsteal abscess
and draining sinuses detachment of periosteum ischemic
necrosis
-di org dewasa deattachment periosteum jarang terjadi karena
periosteum sudah melekat kuat ke articular.

Chronic
Osteoclast activation, fibroblast proliferation and new bone
formation.
Necrosis bone sequestrum
Reactive new bone involucrum
Brodie abscess(?)

The primary site of


infection is usually
in the metaphysial
region, from which
the infection may
spread to involve
the cortex and form
a subperiosteal
abscess; may
spread into the
medullary cavity;
or, rarely, may
spread into the
adjacent joint
space.

Tuberculous Osteomyelitis

Tuberculous = Pott Disease = Spinal Tuberculosis

Mycobacterium tuberculosis attack synovium (high 02 pressure)


adjacent epiphysis granulomatous inflammatory reaction
(caseous necrosis and extensice bone destruction)

Special Symptoms: night sweating


radiologic classification for primary subacute osteomyelitis

modified classification of subacute osteomyelitis. Type I is


metaphyseal. Type Ia is a punched-out central metaphyseal lesion.
Type Ib is an eccentric metaphyseal cortical erosion. Type II is
diaphyseal. Type IIa is a localized cortical and periosteal reaction.
Type IIb is a medullary abscess in the diaphysis without cortical
destruction but with onionskin periosteal reaction. Type III is
epiphyseal. Type IIIa is a primary epiphyseal osteomyelitis. Type IIIb
is a lesion that crosses the epiphysis and involves both the epiphysis
and the metaphysis. Type IV is a metaphyseal equivalent. Type IVa
involves the vertebral body with an erosive or destructive process.
Type IVb involves the flat bones of the pelvis. Type IVc involves the
small bones, such as the tarsal bones.
Harrison's Online > Part 8. Infectious Diseases > Section 2.
Clinical Syndromes. Community-Acquired Infections > Chapter 126.
Osteomyelitis > Osteomyelitis: Introduction > Treatment:
Osteomyelitis >

3. Explain the pathogenesis and principles


treatment of musculoskeletal infection
PATHOGENESIS

of

PRINCIPLE S OF TREATMENT
To get rid of the infection and reduce damage to the bone and
surrounding tissues.
Bed rest or local rest for the infected area of the body.
Antibiotics are given to destroy the bacteria causing the
infection. Antibiotics are taken for at least 4 - 6 weeks, often
through an IV rather than mouth.
Surgery may be needed to remove dead bone tissue if there is
an infection that does not go away.

4. Line out the common causative organism of bone


and joint infections
Table 1 Usual infectious causes of pediatric osteomyelitis and
pyogenic arthritis
Age
Organism
Staphylococcus aureus
Streptococcus agalactiae
Infants 0-2 months
Gram-negative enteric bacteria
Candida
S. aureus
Streptococcus pyogenes
Less than and five years
Streptococcus pneumoniae
Kingella kingae
Haemophilus influenza type b
S. aureus
More than five years
S. pyogenes
Adolescent
Neisseria gonorrhoeae
Table 2 Other microbiologic causes of bone or joint infection in
children
Risk Factor
Organism
Osteomyelitis
Exposure to farm animals
Coxiella burnetti
Kitten exposure
Bartonella
Travel/contact
Mycobacterium tuberculosis
Sinusitis/mastoiditis/dental
Anaerobes
abscess
Puncture wound foot
Pseudomonas,
Staphylococcus
aureus
Sickle cell disease
Salmonella, S. aureus
Coccidioides immitis
Travel or residence in endemic
Blastomyces dermatidis
Histoplasma capsulatum
area immunosuppression
Cryptococcus neoformans
Chronic granulomatous disease
Aspergillus, S. aureus, Serratia
Arthritis

Tick exposure in an endemic area


Travel/ Contact
Rat exposure
Viral infection
Travel or residence in endemic
area immunosuppression
Newborn with intravascular line

Borrelia burgdorferi
M. tuberculosis
Streptobacillus moniliformis
Spirillum minus
Rubella,
parvovirus
B19,
varicella zoater, hepatitis B
C. immitis
B. dermatitidis
H. capsulatum
C. neoformans
Candida

5. Describe the clinical symptoms of musculoskeletal


infection

severe and constant pain in bone


muscle spam and local tenderness, swelling, warmth
fever
septicemia (malaise, anorexia, fever)
In spine, pyogenic infection usually occurs in lumbar and
cervical region but tuberculosis usually occurs in thoracic
region
ESR and WBC elevated in lab test
irregular bone shape that could mimic bone lesion such as
Langerhans cell histiocytosis, Ewings sarcoma, and
osteosarcoma or the presence of obvious sequestra,
pathological dislocation, osteolytic lession and narrowing of
the joints in the radiographic examination
other symptoms may occur; loss of appetite, excessive
sweating, swelling of the ankles, feet and legs

6. Explain the principle of antibacterial therapy in


musculoskeletal infection
7. Table 1262 Antibiotics for the Treatment of Osteomyelitis
8.
Organism

Antimicrobial Dosing
Agent

MethicillinOxacillin or naf 2 g IV
susceptibleStaphylo cillin
q6h
coccus aureus

Comments
May be more active than
cephalosporins
More difficult than
cephalosporins to
administer for long
periods

Organism

Antimicrobial Dosing
Agent

Comments

Cephalosporins Cefazolin Ceftriaxone advantageou


: 2 g IV
s with OPAT
q8h
Ceftriaxo
ne: 12 g
IV q24h
Clindamycina

600900 Not well studied for


mg IV
osteomyelitis
q8h
Oral form possible (300
600 mg oral q8h)
Resistance significant and
increasing
Toxicity different from
that of
-lactam
antibiotics

Methicillin-resistant Vancomycin
S. aureus

15 mg/kg Strains with an MIC


IV q12h of
2
g/mL
may not respond well.

Daptomycina

46
Promising, but concern
mg/kg IV about adverse effects
q24h
with prolonged therapy

Linezolida

600 mg
IV or PO
q12h

Effectiveness and
adverse effects with
prolonged therapy
unclear
Bacteriostatic

Streptococci

Enterococci

Penicillin

Penicillin

5 mU IV
q6h or
20 mU/d
by
continuo
us
infusion

Not all streptococci are


susceptible
Ceftriaxone (1 g/d IV or
IM) and ampicillin (12 g/d
IV) are alternatives

As above If strain is susceptible

plus gentamici 5 mg/kg


n
daily IV

Organism

Antimicrobial Dosing
Agent
Vancomycin

Enterobacteriaceae Ceftriaxone or
(E. coli, Klebsiella,
another
other)
cephalosporin
Ciprofloxacin
Pseudomonas
aeruginosa

Ciprofloxacin

Comments

As above If strain is susceptible


As above If strain is susceptible
400 mg
IV q8
12h

500750 mg q812h if
strain is susceptible

As above Resistance may develop


during therapy; if strain is
resistant, drugs to
consider
include cefepime and ceft
azidime

Not approved for use in osteomyelitis by the U.S. Food and Drug
Administration.
Abbreviations: MIC, minimal inhibitory concentration; OPAT, outpatient
parenteral antimicrobial therapy.

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