Breakin Bones
This is the most common route by which osteomyelitis develops in children.
What is hematogenous spread?
This organism is a common cause of osteomyelitis in prosthetic joints.
What is Staph epidermidis?
Localized bone pain plus warmth, swelling, and erythema with systemic symptoms like fever and chills are classic for this time course of this disease.
What is acute osteomyelitis?
These antibiotics are typically used first-line for MSSA osteomyelitis once cultures and susceptibilities are known.
What are beta‑lactams (nafcillin, oxacillin, or cefazolin)?
Given Jeff’s diagnosis, this was his most likely risk factor. And how did his osteomyelitis likely spread?
What is IVDU, hematogenous spread?
This is why the metaphysis is particularly susceptible to osteomyelitis in children.
What is a rich blood supply with capillary networks that facilitate bacterial seeding?
This organism is classically associated with osteomyelitis in a child with sickle cell disease.
What is Salmonella?
These are the typical labs you would see in osteomyelitis.
Elevated CRP, ESR, and WBC ~15,000 (lower than septic arthritis)
Besides the infection itself, patients with osteomyelitis should also receive treatment for this.
What is pain?
Besides osteomyelitis, name two serious infectious complications associated with injection drug use.
Infective endocarditis, Skin/soft-tissue abscesses, Cellulitis, Septic thrombophlebitis, Bacteremia, Viral infections such as HIV and hep B/C
These are the 3 major mechanisms by which osteomyelitis forms.
What are direct inoculation (open bone, surgery, trauma), Contiguous (from nearby structures, ulcers → bone), Hematogenous spread (distant other infection, lungs, UTI, etc)?
This gram negative rod is a classic cause of osteomyelitis from stepping on a nail through the shoe.
What is Pseudomonas?
When you suspect osteomyelitis, but the blood culture is normal, this would be your next step.
What is a bone biopsy with culture?
This intervention, often required in chronic osteomyelitis or osteomyelitis with necrotic bone and sinus tracts, involves surgically removing devitalized bone and infected soft tissue to achieve source control before or alongside antibiotics.
What is surgical debridement of necrotic bone and tissue?
Jeff was prescribed these medications for his opioid use.
What is Dolophine (methadone) and Suboxone (buprenorphine/naloxone)? Why both?
This finding, characteristic of chronic osteomyelitis, is the appearance of a devascularized, necrotic fragment of bone separated from living bone.
What is a sequestrum?
A patient develops osteomyelitis after a dog bite. This is the most likely organism associated with this exposure.
What is Pasteurella multocida?
___ are insensitive early, but can detect late osteomyelitis. __ are best for detecting osteomyelitis and anatomic involvement.
What are x-rays and MRIs? Why for 100?
While waiting for cultures, your patient’s blood pressure starts dropping and you need to give him antibiotics quick! What are you giving?
Vancomycin and gram neg (meropenem, cefepime, ceftriazone)
200 bonus, what else should you do right now?
Five weeks after starting treatment, Jeff develops worsening back pain. Why was surgery necessary despite the infection being considered successfully treated?
The infection caused structural destruction and deformity of the spine with spinal cord compression.
Explain how hematogenous infection can ultimately lead to destruction of the vertebral bodies, involvement of the intervertebral disc, and spinal cord compression.
Bacteria seed the vertebral endplates → inflammatory response and infection cause bone destruction → infection spreads across the adjacent endplates into the intervertebral disc → progressive vertebral destruction/collapse can cause deformity and narrowing/compression of the spinal canal/spinal cord.
This yeast can cause osteomyelitis in immunocompromised and IVDU. What else does it cause in IVDU?
What are Candida and infective endocarditis?
This is a bedside physical exam maneuver used to detect osteomyelitis.
What is probe-to-bone?
If a patient with osteomyelitis develops signs of one of these 3 complications, antibiotics should not be delayed for culture results.
What are septic shock/hemodynamic instability, spinal epidural abscess, and new or progressive neurologic symptoms?
After surgery, Jeff requires pain control. He is taking medication for opioid use disorder. Before prescribing additional opioids, why is it important to know whether he is taking methadone or buprenorphine?
Because both affect opioid receptor activity and can alter the response to additional opioids; methadone increases cumulative opioid effects and respiratory-depression risk, while buprenorphine's high μ-receptor affinity can reduce the effectiveness of full opioid agonists.