23. Inflamación del hueso producida por
un agente infeccioso. Puede
permanecer localizada o extenderse
por el hueso para afectar medula,
cortical, periostio o los tejidos blandos
circundantes.
Campbell, Cirugia ortopédica. Terry
Canale, et all. 11ª edición. 2007. Mosby
24. Lew y WaldvogelLew y Waldvogel
• Duración
- Aguda
- Crónica
• Fuente de infección
- Hematógena
- Contigua
- En presencia de insuf. vascular
Osteomyelitis in Long Bones, JBJS, J Bone Joint Surg Am.
2004;86:2305-2318. Lazzarini, Mader, Calhoun
35. EstudiosEstudios
• Rx AP, lat y oblicuas (10 a 14 días)
• Fistulografía
• Gammagrafía (Galio, Tec99, Indio 111)
• Tomografía
• CH, VSG, Proteínas, Tiempos,
Uroanálisis, cultivo, antibiograma,
hemocultivos, cultivo de fragmento óseo,
estudio histopatológico
Contrary to common belief, swab cultures from draining
wounds and sinus tracts can be of diagnostic benefit for two
main reasons. First, the identification of certain resistant
microorganisms (e.g., methicillin-resistant S. aureus,
vancomycin-resistant enterococcus) indicates the need for
infection control measures. Second, the isolation of S.
aureus from superficial cultures has a high degree of
correlation with deep cultures
49. Key wrote: “continuous drug over a long
period of time will lessen the amount of
discharge, but it will not cure
the disease because it cannot sterilize dead
bone or cavities with necrotic content and
rigid walls.”
Osteomyelitis in Long Bones, JBJS, J Bone Joint Surg Am.
2004;86:2305-2318. Lazzarini, Mader, Calhoun
dog or cat bite include Pasteurella multocida and Capnocytophaga spp., and in the case of a human bite, Eikenella corrodens and Fusobacterium nucleatum.77-79 Streptobacillus moniliformis, a causative agent of rat-bite fever, is occasionally isolated from the blood or synovial fluid in patients with a polyarticular arthritis after a rat bite
A, Septic arthritis of the symphysis pubis. Computedtomography of the pelvis reveals joint space widening with subchondral bone resorption and disruption of the articular cortical margins. B, Septic sacroiliac joint. Coronal T2-weighted MR image demonstrates fluid within the right sacroiliac joint, spreading superiorly and inferiorly to form soft tissue abscesses. (From: Chew FS, Maldjian C, Leffler SG. Musculoskeletal imaging: A Teaching file. Lippincott Williams & Wilkins; 1999:267, with permission.)
aAll indicated dosages are intravenous for patients with normal renal function. bTherapeutic monitoring to achieve trough levels of 15-20€mg/L is indicated. cIf culture yields methicillin-susceptible S. aureus, therapy should be narrowed to an antistaphyloccocal PCN or first generation cephalosporin. dFor patients allergic to, or intolerant of, vancomycin: linezolid or daptomycin. eFor patients with previous history of an extended-spectrum β-lactamase infection or colonization, a carbapenem is preferred over other β-lactam antimicrobials including aztreonam. fCan be given orally as ciprofloxacin 750€mg q 12 hours, or levofloxacin 750€mg q 24 hours. ABW, actual body weight; PCN, penicillin; CEPH, cephalosporin; FQ, fluoroquinolone.
Additionally, lipid preparations of amphotericin B have modestly reduced the toxicity of this drug, increasing the safety of long-term amphotericin therapy. Treatment recommendations for native joint Candida arthritis are for amphotericin B deoxycholate (0.5-1€mg/kg/day) for 2-3 weeks followed by fluconazole to complete a total duration of therapy of 6-12 months.212 Lipid-associated amphotericin B (3-5€ mg/kg/day) may be substituted for patients who are intolerant of amphotericin or exhibit amphotericin B–related nephrotoxicity. Limited experience suggests that fluconazole as initial therapy (6€mg/kg/day) and continued for 6-12 months may also be effective for joint infections due to susceptible Candida spp. Fluconazole, if used, may be given orally.
T1-weighted MR image shows abnormal signal in the disk between L2 and L3 with associated vertebral osteomyelitis. A fluid collection is located in the posterior part of L2 and L3 resulting in the elevation of the posterior ligament. A CT-guided aspirate grew Staphylococcus aureus.
