august 20, 2010. 1% of pediatric admissions neonates* hematogenous spread* tibia or femur 50%...
TRANSCRIPT
![Page 1: August 20, 2010. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli](https://reader035.vdocument.in/reader035/viewer/2022070401/56649f1d5503460f94c33c29/html5/thumbnails/1.jpg)
GOOD MORNINGIT’S FRIDAY!!!
August 20, 2010
![Page 2: August 20, 2010. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli](https://reader035.vdocument.in/reader035/viewer/2022070401/56649f1d5503460f94c33c29/html5/thumbnails/2.jpg)
![Page 3: August 20, 2010. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli](https://reader035.vdocument.in/reader035/viewer/2022070401/56649f1d5503460f94c33c29/html5/thumbnails/3.jpg)
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
![Page 4: August 20, 2010. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli](https://reader035.vdocument.in/reader035/viewer/2022070401/56649f1d5503460f94c33c29/html5/thumbnails/4.jpg)
Osteomyelitis
Direct invasion Spread from focus
Trauma Staph aureus
Puncture Pseudomonas
Sole of sneaker E. coli
Animal Bite Anaerobes Staph
![Page 5: August 20, 2010. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli](https://reader035.vdocument.in/reader035/viewer/2022070401/56649f1d5503460f94c33c29/html5/thumbnails/5.jpg)
Osteomyelitis
Hematogenous* Acute pain and decreased movement* Possible swelling or redness* Systemic Symptoms
Fever Malaise Irritability
![Page 6: August 20, 2010. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli](https://reader035.vdocument.in/reader035/viewer/2022070401/56649f1d5503460f94c33c29/html5/thumbnails/6.jpg)
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
![Page 7: August 20, 2010. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli](https://reader035.vdocument.in/reader035/viewer/2022070401/56649f1d5503460f94c33c29/html5/thumbnails/7.jpg)
Osteomyelitis
Lab findings
Elevated or normal leukocyte
ESR/CRP elevated
Positive blood culture 50%
![Page 8: August 20, 2010. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli](https://reader035.vdocument.in/reader035/viewer/2022070401/56649f1d5503460f94c33c29/html5/thumbnails/8.jpg)
Osteomyelitis
Imaging Plain films
1-2 weeks* Edema of surrounding tissues Periosteal reaction New bone formation
2 weeks Lytic lesions
![Page 9: August 20, 2010. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli](https://reader035.vdocument.in/reader035/viewer/2022070401/56649f1d5503460f94c33c29/html5/thumbnails/9.jpg)
Osteomyelitis
Imaging* Bone Scan
2-3 days Unclear location Nonspecific
MRI Specific Abscess
![Page 10: August 20, 2010. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli](https://reader035.vdocument.in/reader035/viewer/2022070401/56649f1d5503460f94c33c29/html5/thumbnails/10.jpg)
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
![Page 11: August 20, 2010. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli](https://reader035.vdocument.in/reader035/viewer/2022070401/56649f1d5503460f94c33c29/html5/thumbnails/11.jpg)
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
![Page 12: August 20, 2010. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli](https://reader035.vdocument.in/reader035/viewer/2022070401/56649f1d5503460f94c33c29/html5/thumbnails/12.jpg)
Osteomyelitis
Treatment
Sickle Cell 3rd generation cephalosporin
Other bugs to consider Pseudomonas, anaerobes, GBS and E. coli
![Page 13: August 20, 2010. 1% of pediatric admissions Neonates* Hematogenous spread* Tibia or femur 50% associated with septic joint* GBS & E.Coli](https://reader035.vdocument.in/reader035/viewer/2022070401/56649f1d5503460f94c33c29/html5/thumbnails/13.jpg)
Osteomyelitis
Complications
Recurrence 5-10% are chronic
Abscess