Dr. Najeeb - Osteomyelitis Part-
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In the case of osteomyelitis of the clavicle, the preferred treatment is debridement of the necrotic bone, followed by 6 weeks of parenteral antibiotic therapy. Patients with clavicular osteomyelitis should be treated with antibiotics for 8 to 12 weeks.
In the case of osteomyelitis that involves the metaphysis of the long bones, local or intramedullary surgical debridement is generally the preferred treatment for an infected hematoma. Metaphyseal osteomyelitis is usually managed with intravenous antibiotics for at least 6 to 12 weeks and after surgical intervention.
The diagnosis of osteomyelitis is made by demonstrating bone inflammation on imaging studies. A bone scan, computed tomography (CT), or magnetic resonance imaging (MRI) scan demonstrates increased uptake and localization of the radionuclide at sites of active inflammation. Pain and fever are the classic clinical manifestations of acute osteomyelitis, but the absence of both of these findings should prompt the clinician to perform more aggressive diagnostic studies in order to rule out other serious conditions, such as infections involving the paranasal sinuses or vertebral bodies. A bone biopsy is often performed in order to obtain material for culture and antimicrobial susceptibility testing. The biopsy, however, is not essential to the diagnosis of osteomyelitis.
The treatment of osteomyelitis in patients with sickle cell disease is complex and requires an interdisciplinary approach. Antibiotic treatment is performed according to the results of antimicrobial susceptibilities, and the duration of treatment should be determined on the basis of the results of the culture and susceptibility tests. In most cases, treatment with parenteral antibiotics is required for at least 6 weeks and often for several months. We recommend the following regimens for the treatment of osteomyelitis in patients with sickle cell disease: (1) parenteral antibiotics for a minimum of 6 weeks, (2) a second-generation cephalosporin or a carbapenem, or (3) a combination of these antibiotics.
Septic arthritis is the inflammation of a joint, caused by the presence of microorganisms in the joint and joint space. Septic arthritis occurs as the result of a septic focus (ie, an infected cellulitis or wound, osteomyelitis, or intraosseous abscess) or the direct spread of infection from the bloodstream. The infection usually begins in the synovial fluid; however, microorganisms are present in the bloodstream, and these organisms enter the joint via the bloodstream. Although various microorganisms can cause septic arthritis, the most common causative agents are S aureus and Streptococcus species.
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