Osteomyelitis, Hematogenous

Hematogenous osteomyelitis, empiric therapy, osteomyelitis children

Clinical Setting
• Empiric therapy for hematogenous osteomyelitis. Select antibiotics appropriate for patient age. Revise quickly to specific therapy according to culture results.
• Osteomyelitis of long bones is more common in children. Vertebral osteomyelitis most common site in adults. Other bones less commonly involved.
• Bone culture essential unless likely pathogen is recovered from blood.
• If patient is not clinically ill and a diagnostic procedure is planned, antibiotics can be held until after the procedure
• See also Vertebral osteomyelitis.

Etiologies
• Age Newborn to < 4 months: NAME_1. aureus, Group B Streptococcus, enteric gram-negative bacilli
• Age 4 months to adult: NAME_1. aureus, Group A Streptococcus; enteric gram-negative bacilli are uncommon
• Salmonella species consideration in developing countries or among patients with sickle cell disease
• Increased recognition of infection due to Kingella kingae in children under age 4. 

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