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Good Morning It’s Friday!!!

Good Morning It’s Friday!!!. August 20, 2010. Osteomyelitis. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli Older children* Staph aureus * , Group A Strep, HIB, Salmonella (SCD) Rare joint involvement.

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Good Morning It’s Friday!!!

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  1. Good MorningIt’s Friday!!! August 20, 2010

  2. Osteomyelitis • 1% of pediatric admissions • Neonates* • Hematogenous spread* • Tibia or femur • 50% associated with septic joint* • GBS & E.Coli • Older children* • Staph aureus*, Group A Strep, HIB, Salmonella (SCD) • Rare joint involvement

  3. Osteomyelitis • Direct invasion • Spread from focus • Trauma • Staph aureus • Puncture • Pseudomonas • Sole of sneaker • E. coli • Animal Bite • Anaerobes • Staph

  4. Osteomyelitis • Hematogenous* • Acute pain and decreased movement* • Possible swelling or redness* • Systemic Symptoms • Fever • Malaise • Irritability

  5. Osteomyelitis • Following trauma • Insidious, subacute onset • Localized pain, edema and redness • Absence of systemic symptoms • Chronic • Local findings may be absent or intermittent • Possible sinus tracts • Absence of systemic symptoms

  6. Osteomyelitis • Lab findings • Elevated or normal leukocyte • ESR/CRP elevated • Positive blood culture • 50%

  7. Osteomyelitis • Imaging • Plain films • 1-2 weeks* • Edema of surrounding tissues • Periosteal reaction • New bone formation • 2 weeks • Lytic lesions

  8. Osteomyelitis • Imaging* • Bone Scan • 2-3 days • Unclear location • Nonspecific • MRI • Specific • Abscess

  9. Pelvic Osteomyelitis* • Stats • Older children • Mean 8.1y • Boys > Girls • Ilium > ischium or pubis • Right > left • Increased risk for abscess formation • Late diagnosis • Staph aureus

  10. Osteomyelitis • Treatment* • High dose • Bactericidal levels in bone • 4-6 weeks • Staph or Strep • Oxacillin or naficillin • 1st or 2nd generation cephalosporins • Clindamycin • HIB • 2nd or 3rd generation cephalosporin

  11. Osteomyelitis • Treatment • Sickle Cell • 3rd generation cephalosporin • Other bugs to consider • Pseudomonas, anaerobes, GBS and E. coli

  12. Osteomyelitis • Complications • Recurrence • 5-10% are chronic • Abscess

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