Osteomyelitis

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  1. Osteomyelitis Microorganisms
    • • Most likely pathogen- S. aureus
    • • Foreign materials/implants- Staphylococci other than S. aureus
    • • Contamination- Pseudomonas
  2. Osteomyelitis Tx Duration
    • • Acute- minimum 4‐6 wks
    • • Chronic- minimum 6‐12 wks
    • • 2‐6 wks of IV with potential transition to PO to complete
  3. Empiric Gram + Oseteomyelitis Tx (Preferred)
    Vancomycin IV ± Rifampin IV/PO
  4. Empiric Gram + Oseteomyelitis Tx (Alternative)
    • • Linezolid 600 mg IV/PO Q12H
    • • Daptomycin 6 mg/kg IV once daily
    • • ± Rifampin IV/PO
  5. MSSA Osteomyelitis Tx
    • • Nafcillin or oxacillin 2g IV q4h
    • • Cefazolin 2g IV q8h or ceftriaxone 2g IV q24h
    • • ± Rifampin IV/PO 600 mg IV q6h or 900mg IV q8h
  6. MRSA Osteomyelitis Tx
    • • Continuation of empiric vancomycin therapy
    • • Linezolid 600 mg PO Q12H
    • • ± Rifampin IV/PO 600 mg IV q6h or 900mg IV q8h
  7. Streptococci Osteomyelitis Tx
    • • Penicillin G 2‐4 MU IV q4‐6h
    • • Cefazolin 2g IV q8h or ceftriaxone 2g IV q24h
  8. Mixed Osteomyelitis Tx
    • • Ampicillin/sulbactam 3g IV q6h (no Pseudomonal coverage)
    • • Piperacillin/tazobactam 3.375g IV q4‐6h (likely Pseudomonas)
  9. Enterobacteriaceae (not P. aeruginosa) Osteomyelitis Tx
    • • Ceftriaxone 2g IV q24h
    • • Ertapenem 1g IV q24h
  10. P. aeruginosa Osteomyelitis Tx
    • • Ciprofloxacin 400mg IV q8‐12h; 750mg PO q12h
    • • Levofloxacin IV/PO 750 mg daily
    • • Cefepime 2g IV q12h
  11. Staphylococci (especially MRSA) Osteomyelitis (Consolidative or Suppressive Oral Regimen)
    • • TMP/SMX DS 2 tabs PO BID‐TID
    • • Linezolid 600 mg PO q12h
    • • Clindamycin 300‐450 mg PO QID + rifampin
  12. MSSA, Streptococci, GNB, Anaerobes Osteomyelitis (Consolidative or Suppressive Oral Regimen)
    Amoxicillin/clavulanate 500 mg PO q8h
  13. Enterobacteriaceae Osteomyelitis (Consolidative or Suppressive Oral Regimen)
    • • Ciprofloxacin 750 mg PO q12h
    • • Levofloxacin 500‐750 mg PO q24h
  14. Anaerobes Osteomyelitis (Consolidative or Suppressive Oral Regimen)
    Metronidazole 500 mg PO q6‐8h
  15. Septic Arthritis Microorganisms
    • • Most common pathogen- S. aureus
    • • Neonates & young children- Streptococcus
    • • Older children & healthy adults- Staphylococcus
  16. Bacterial, Nongonococcal Septic Arthritis
    • • Fever, chills, elevated WBCs
    • • Monoarticular
  17. Gonococcal Septic Arthritis
    • • N. gonorrhoeae
    • • Triad: vesicular skin lesions, tenosynovitis, migratory arthritis or arthralgia
    • • Polyarticular
  18. Empiric Septic Arthritis: Neonates and Children
    • • Gram‐positive and ‐negative organisms
    • – Infants (<1 mo): nafcillin or oxacillin PLUS cefotaxime
    • – Children: nafcillin, oxacillin, or cefazolin
  19. Empiric Septic Arthritis Adults
    • • Gram‐positive organisms
    • • Add coverage for gram‐negative organisms if revealed on gram stain
    • • Consider gonococcal septic arthritis
    • → If risk for STDs, polyarticular
    • → Drug of choice: ceftriaxone 1g IV/IM q24h
  20. Empiric Gram + Septic Arthritis
    Vancomycin
  21. Empiric Gram - Septic Arthritis
    • • Ceftriaxone
    • • Cirpofloxacin/levofloxacin
  22. Septic Arthritis Duration of Tx
    • • S. aureus: 4‐6 weeks
    • • Streptococci: 2‐4 weeks
    • • Gram negative bacteria: 4 weeks
  23. MSSA Septic Arthritis Tx
    • • Nafcillin or oxacillin 2g IV q4h
    • • Cefazolin 2g IV q8h
  24. MRSA Septic Arthritis Tx
    Vancomycin IV (Troughs 15‐20 mcg/mL)
  25. Streptococci Septic Arthritis Tx
    • • Penicillin G 12‐18 MU IV/day
    • • Ampicillin 2g IV q4h
  26. S. pneumoniae Septic Arthritis Tx
    • • Ceftriaxone 1‐2g IV q12‐24h
    • • Cefotaxime 2g IV q8h
    • • Vancomycin IV (Troughs 15‐20 mcg/mL)
  27. Enterobacteriaceae Septic Arthritis Tx
    • • Ceftriaxone 1‐2g IV q12‐24h
    • • Cefotaxime 2g IV q8h
    • • Ciprofloxacin 400mg IV q8‐12h or 750mg PO q12h
    • • Levofloxacin 750mg IV/PO daily
  28. P. aeruginosa Septic Arthritis Tx
    • • Cefepime 2g IV q8h
    • • May add aminoglycoside for double coverage
  29. Polymicrobial Septic Arthritis Tx
    • • Ampicillin/sulbactam 1.5‐3g IV q4h
    • • Clindamycin 600 mg IV q6‐8h PLUS cipro‐/levofloxacin
  30. CABG, Hip/Knee Arthroplasy Prophylaxis
    • • Cefazolin
    • • Cefuroxime
    • • Vancomycin
  31. Colorectal Prophylaxis
    • • Ampicillin/sulbactam
    • • Cefotetan
    • • Cefoxitin
    • • Ertapenem
    • • Cefazolin C metronidazole
  32. Hysterectomy Prophylaxis
    • • Cefoxitin
    • • Cefotetan
    • • Cefazolin
    • • Cefuroxime
    • • Ampicillin/sulbactam
Author:
ebmalonzo
ID:
316198
Card Set:
Osteomyelitis
Updated:
2016-02-20 23:05:20
Tags:
Osteomyelitis
Folders:
ID 1
Description:
ID 1 (Final): Osteomyelitis
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