Upon completion of the chapter the reader will be able to

1. Discuss the pathophysiology of osteomyelitis.

2. List common risk factors for osteomyelitis.

3. Compare and contrast the classic signs and symptoms of acute and chronic osteomyelitis.

4. Evaluate microbiology culture data and other laboratory tests utilized for the diagnosis and treatment of bone infections.

5. List the most common pathogens isolated in acute and chronic osteomyelitis.

6. Develop a treatment plan for osteomyelitis.

7. Recommend parameters to monitor antimicrobial therapy for effectiveness and toxicity.

8. Educate patients regarding disease state and drug therapy. key concepts

0 Osteomyelitis, an infection of the bone, can be an acute or chronic process.

01 Osteomyelitis is most often classified by route of infection and duration of disease.

Staphylococcus aureus is the predominant pathogen seen in all types of osteomyelitis. However, the spectrum of potential causative pathogens varies with patient-specific risk factors and route of infection.

Typical signs and symptoms of osteomyelitis include local pain and tenderness over the affected bone, as well as inflammation, erythema, edema, and decreased range of motion. Patients with acute hematogenous osteomyelitis may also present with fever, chills, and malaise.

The gold standard for diagnosis of osteomyelitis is a bone biopsy with isolation of microorganism(s) from culture and the presence of inflammatory cells and osteonecrosis on histological exam.1-3 Due to the invasive nature of the bone biopsy, the diagnosis of osteomyelitis is often based upon on clinical findings, laboratory tests, and imaging studies rather than bone biopsy.4 A thorough history and physical examination are especially important for diagnosis in patients with limited or atypical symptoms.

The treatment goals for acute and chronic osteomyelitis are to eradicate the infection and prevent recurrence. Higher cure rates are seen with acute compared to chronic osteomyelitis. Therefore, in chronic osteomyelitis, a common treatment goal for many patients is to prevent complications such as amputation.

Treatment of osteomyelitis is dependent on the extent of bone necrosis. For acute osteomyelitis with minimal bone destruction, an extended course of antimicrobial therapy should effectively treat the infection; however, in chronic osteomyelitis surgical intervention is also typically required.

Empiric antimicrobial therapy should target likely causative pathogen(s) based on patient-specific risk factors and route of infection. However, therapy should be modified based on culture and sensitivity data.

The total duration of antimicrobial therapy is typically 4 to 6 weeks. Therapy is often administered IV for 1 or 2 weeks and then switched to the oral route.

® Patients should be monitored for clinical and laboratory response, development of adverse drug reactions, and potential drug-drug interactions. Patients should also be closely monitored for compliance in the outpatient setting.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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