Contiguous Focus Osteomyelitis With Vascular Insufficiency

• Multiple pathogens often isolated

• Mixture of aerobic and anaerobic organisms

• Staphylococcus aureus, Enterococcus spp., Enterobacteriaceae, Pseudomonas aeruginosa, anaerobes

Table 81-1 Empiric Antimicrobial Therapy for Osteomyelitis

Age of Ûnset

Infection 5i:e

link Factor:

Typli a 1 fill liigcjll

Antimicrobial Thtfipy

Hematogenous

(femur, (IfcJJl

1 IJ.J.'L-Ui i.(Oti i>n?iip 0 streptococci

ArHiSLdpliiy1c<ûCtjl lägen!* le (|. njicfflln oi vdiiiomyiirfl and

Jrd/iJi fltnefMlon Ct(/Ul«)»tin vdfi exception of ceftris*c*ie

Prepubertal

Long bon«

J. oifeus

Arrtlslaptylococial agent'

(ieimii, (IfcüO

Clindamycin'

fkterly

■tfslirbta

UTI

S.auirus £«f

Anlistapiiylococial agent*

3rd/4th generation cephalosporin

CijniigiWui

Wfiïh VJSCULJI

Adud (older

Feel, lingers

Diabetes, PVD.

Î.MMUS (MR5A1

Seveial Iherapcdlk onions;

insufficiency

[h-f. M

peripheral neuropil lny

trueiutuc P. oefugmna

Vancomycin^ and

EnftrortJCCLT spp Anaaobes

(!) Piperacillir^tarobaclamor

¡/î im iHiHtn/i .i^uiiin. (heiooertem dorlpenemor fj) Gefepimeor ceftaiidime and i lirXLiliiyv iniW rnenonitlvi*1!« 14) Gpiofk»iacln or tevafltHaoi and dindamytii or medonidaiofc

Wi;hoji vascm'ar

Aft il Initier

Postoperative

S.öi-ifus

ArKlstapliylococfal agent*

insufficiency

tlunSOyeais)

(ejg^hip fi-wiiiiesl icft-tisHie infettions

MRSA, milhkÄn ieiinlan inqptytococtuj ouneus PVD, peripheral vj&culai disease, UTI, urlruy (rjcE infection.

MRSA, milhkÄn ieiinlan inqptytococtuj ouneus PVD, peripheral vj&culai disease, UTI, urlruy (rjcE infection.

If the patiem has tibi facias fa MFlSA a prevalence of communityassociaHed MRSA Is high vancomycin should be substituted for ndfcillin, mjcillin. Jnd cflijÄoiin.

I he üouiwl nmst be- fuBy m«cp(i we (D-tJüJO w î lindamyon.

if v^Kowx ¡n minimum inhiCiKiy concetiuason (MKlj ü gratet Hun c* equal to JjOnnijQ/tinUi 4 i*ncVL) i^ainsi mrsa^ consider jn agent !«Kh » IhezgW ordbptcntydn

FiOITi (tek J, Î-! J, ïl. JÎ, 50-.JÎ, 54-56,5B.

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