Most common organism in drug abusers chronic osteomyelitis is
(Pseudomonas) (447-current diagnosis & Treatment 4th)Most common Organism in Osteomyelitis* Acute osteomyelitis- children under 4 years of age. H. influenzae* Acute osteomyelitis in older children, adults - Staph.aureus* Sickle cell disease - Salmonella* Heroin addicts and immunocompromized - Pseudomonas, aeruginosa, proteus mirabilis, Bacteroids* Sub acute haematogenous osteomyelitis - Staph, aureus* Post traumatic osteomyelitis, Infected metal implants Staph, aureus* Post operative osteomyelitis - Mixed infection (Staph, aureus Proteus, Pseudomonas)* Osteomyelitis of the spine - Staph, aureus, Pseudomonas aeruginosa* Squamous cell carcinoma arising from a chronic osteomyelitis - occurs in areas of bum scars, chronic pressure ulcers, and ostomies as well as as sites of chronic draining osteomyelitisStable chronic osteomyelitis for an average of approximately 20 years (447-CDT- orthopedics 4th)* Earliest site of bone involvement in hematogenous osteomyelitis is - Metaphysis**Markers of Bone formationMarkers of Bone resorption* Serum bone specific alkaline phosphatase*** Serum osteocalcin* Serum propeptide or type I procollagen* Urine and serum N- telopeptide* Urine and serum C- telopeptide** Urine total free deoxypyridinoline* Urine Hydroxyproline** Serum tartarate resistant- Acid phosphatase** Serum bone sialoprtein* Urine hydroxylysine glycosides* Infective endocarditis due to pseudomonas is most commonly seen with IV drug abuse of pentazocin**Classification systems for Osteomyelitis1.Traditional system- Acute (<2 weeks) subacute (weeks to months) chronic (>3months)2.Waldvogel system- Hematogenous- Arising from contiguous infection No vascular disease- Vascular disease present chronic3.Cierny- Mader systemAnatomic extent of infection1. Medullary only (acute hematogenous)2. Superficial cortex (continguous spread or soft tissue trauma)3. Localized (cortical and medullary, mechanically stable)4. Diffuse (cortical and medullary mechanically unstable)5.Subtype by host's physiologic statusA HealtyBs Compromised because of systemic factorsB1 Compromised because of local factorsB1s Compromised because of both local and systemic factorsC Treatment worse than the disease
Staph.aureus
Pseudomonas
Granulmatous
klebsiella
Infection of Bones & Joints