Osteomyelitis Treatment

What is the most successful medical treatment of Enterococcal Osteomyelitis?

Outline of management of enterococcal osteomyelitis is on similar lines as any other osteomyelitis. Ideally, antibiotics are chosen as per culture sensitivity report though initially patient may be put on Second or third generation cephalsporins in combination with aminoglycosides like Gentamycin or Amikacin.

Could MRI be used successfully in distinguishing normal areas from abnormal areas when surgery is being planned for diabetic patients with osteomyelitis?

MRI will be able to clearly demarcate abnormal areas, but practically speaking it is not required, as surgical treatment of osteomyelitis does not require total excision of the affected bone (as in tumors) but only the sequestrum and possibly some of the avascular bone.

How pyogenic osteomyelitis occur? How to confirm the diagnosis?

Pyogenic osteomyelitis is mostly of hematogenous in origin, resulting from an infective thrombus settling down in metaphyseal area of bone. The other mode of infection is direct involvement by contamination of bone as seen in open fractures.

The diagnosis of osteomyelitis can be suspected from clinical & radiological features and the confirmation is possible by pus culture & sensitivity.

Can osteomyelitis of the spine produce severe pain?

One of the important features of infection of bone is pain due to inflammation. Certainly, infection of spine is no exception.

What surgical procedures are under taken for treating a chronic osteomyelitis where medical management has failed?

Common Surgical procedures for chronic osteomyelitis are sequestrectomy and saucerisation.

How mycotic infections occur in bones and joints?

Fungi reside in soil. Therefore, the mode of mycotic infection of bone & joints is usually by direct inoculation as in thorn prick etc.

How to differentiate between haemoto-genous ostemoyelitis and suppurative arthritis?

1. Osteomyelitis primarily affects the metaphyseal area of bone & does not affect the joints as epiphyseal plate acts as a barrier.
2. Therefore the joint remains normal. In contrast, suppurative arthritis involves the joint and therefore will present as pus in the joint with fluctuation & painful limitation of movements.
3. Aspiration of joint will also reveal pus in suppurative arthritis.
4. It is said that about 75% of haematogenous acute infections of bone are due to staphylococci, how true is it.
5. Yes, Staphylococcus is the most common organism causing hematogenous osteomyelitis.

Is there any highly effective broad-spectrum antibiotic for the treatment of chronic pyogenic osteomyelitis?

Patient can be put on any broad-spectrum antibiotic e.g. Cefuroxime or Ceftriaxone etc but it should be substituted with appropriate antibiotics as per culture sensitivity report.

How we can diagnose a case of osteomyelitis of the spine?

• Infective condition of spine can be suspected following clinical features of pain, fever, local tenderness, & radiological features like bone destruction & irregular reduction of disc space.
• Special investigations like MRI & radioisotope bone scanning can be useful. Definitive diagnosis can only be made by doing a needle biopsy & subjecting it to histopathology & culture sensitivity.

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• Disease and Treatment