Osteomyelitis

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References: 1. Urish KL, Cassat JE. Staphylococcus aureus Osteomyelitis: Bone, Bugs, and Surgery. Infect Immun. 2020 Jun 22;88(7):e00932-19. doi: 10.1128/IAI.00932-19. PMID: 32094258; PMCID: PMC7309607. 2. Maffulli N, Papalia R, Zampogna B, Torre G, Albo E, Denaro V. The management of osteomyelitis in the adult. Surgeon. 2016 Dec;14(6):345-360. doi: 10.1016/j.surge.2015.12.005. Epub 2016 Jan 21. PMID: 26805473. 3. Momodu II, Savaliya V. Osteomyelitis. 2021 Feb 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30335283. 4. Tice, A.D., Hoaglund, P.A. and Shoultz, D.A., 2003. Risk factors and treatment outcomes in osteomyelitis. Journal of antimicrobial chemotherapy, 51(5), pp.1261-1268. 5. Tseng CH, Huang WS, Muo CH, Chang YJ, Kao CH. Increased depression risk among patients with chronic osteomyelitis. J Psychosom Res. 2014 Dec;77(6):535-40. doi: 10.1016/j.jpsychores.2014.09.008. Epub 2014 Sep 16. PMID: 25258357.

Osteomyelitis

Outcomes 4

Often diagnosing the causative agent is difficult, and antibiotic therapy requires changing, this can affect the outcome for patients.

Outcomes depend on several factos

Predisposing factors such as diabetes, early diagnosis, location, early intervention impact outcomes.

Long hospital stays, and surgical outcomes factor in to patient outcomes.

If amputation is required this will have a significant impact on patient quality of life.

Surgical intervention is associated with poor outcomes and recovery.

Psychosocial impacts vary greatly. Often anxiety, depression and isolation are related to lengthy hospital stays.

With early intervention, most patients make a full recovery.

Psychosocial Outcomes

Cost of hospital admission during treatment is significant.

Chronic Osteomyelitis has a more severe psychosocial impact with multiple hospitalisations and surgeries.

Early detection is key in minimising costs associated with treatment

Increased levels of depression and other co-morbidities are associated with diagnosis of Chronic osteomyelitis [5]

Diagnosis 3

Aspiration of the affected area for collection and analysis of tissue is the gold standard for diagnosis.

Blood testing can help detect osteomyelitis, however has low specificity.

ESR and CPR rates are useful in detection, however they have low specificty.

Blood culture is can detect pathogens if spread hematogenously

Diagnostic Imaging can be utilised.

MRI is more effective

X-Ray imaging is poor at early detection

Diagnosis is complex often requires several diagnostic procedures

Patient presentation plays a huge role in diagnosis.

Fever, local pain and refusal to use affected limb are all common presentations.

Management 2

Management often requires extensive hospital stays, exceeding 4 weeks.

Non-Surgical

IV antibiotic therapy. Antibiotic prescription varies depending on causative agent.

Surgical

Surgical treatment involves aspiration of the affected bone.

Includes removal of dead tissue, purulent matter and amputation.

Pathophysiology

Can be acute or chronic in nature

Causes destruction and necrosis of the infected bone

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Often aquired from a primary infection elsewhere in the body

Spread directly from open wound

Hematogenous spread

Bacterial or fungal infection

Staphylococcus Aureus is the most common causative agent (70%) 1