Materiały źródłowe

• #1 Osteomyelitis: Approach to Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2696389/

  Osteomyelitis is a common disease with a variety of clinically and microbiologically distinct subsets. Diagnosis should begin with plain radiographs but may include a variety of imaging modalities. Cultures of the surface of ulcers or draining sinuses are often misleading, and bone cultures are necessary to determine the true pathogens of bone infections. […] The diagnosis of osteomyelitis may be difficult. If an ulcer is present on exam, osteomyelitis is present if bone is visible, or if bone is encountered when the ulcer is probed with a sterile instrument. However, the inability to probe to bone does not rule out osteomyelitis. […] Routine laboratory tests are usually nonspecific. The white blood cell count is often normal even in the setting of acute osteomyelitis. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are often elevated; however, they both lack specificity in the absence of other radiologic and microbiologic data.

• #1 Osteomyelitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteomyelitis/diagnosis-treatment/drc-20375917

  Your healthcare professional may feel the area around the affected bone for tenderness, swelling or warmth. If you have a foot sore, your healthcare professional may use a dull probe to see how close the sore is to the bone under it. […] You also might have tests to diagnose osteomyelitis and to find out which germ is causing the infection. Tests may include blood tests, imaging tests and a bone biopsy. […] Blood tests can show high levels of white blood cells and other markers in the blood that may mean that your body is fighting an infection. Blood tests also may show which germs caused the infection. […] No blood test can tell whether you have osteomyelitis. But blood tests can help your healthcare professional decide what other tests and procedures you may need. […] X-rays can show damage to a bone. But the damage may not show on X-rays until osteomyelitis has been there for weeks. You may need more-detailed imaging tests if your infection is more recent. […] A bone biopsy can show what type of germ has infected your bone. Knowing the type of germ helps your healthcare professional choose an antibiotic that works well for the type of infection you have.

• #1 Osteomyelitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p395.html

  Osteomyelitis is usually clinically diagnosed with support from imaging and laboratory findings. […] Bone biopsy and microbial cultures offer definitive diagnosis. […] The preferred diagnostic criterion for osteomyelitis is a positive bacterial culture from bone biopsy, but clinical, laboratory, and radiographic findings can also inform a clinical diagnosis. […] Magnetic resonance imaging is the imaging modality of choice for suspected osteomyelitis, although plain film radiography is often done initially. […] A diagnosis of osteomyelitis should be considered in any patient with acute onset or progressive worsening of musculoskeletal pain accompanied by constitutional symptoms such as fever, malaise, lethargy, and irritability. […] The index of suspicion for osteomyelitis should be higher in patients with underlying conditions, including poorly controlled diabetes mellitus, neuropathy, peripheral vascular disease, chronic or ulcerated wounds, history of recent trauma, sickle cell disease, history of implanted orthopedic hardware, or a history or suspicion of intravenous drug use.

• #1 Strategies to make a definitive diagnosis of osteomyelitis – Today’s Hospitalist

  https://todayshospitalist.com/Strategies-to-make-a-definitive-diagnosis-of-osteomyelitis/

  The elderly patient presents with a foot ulcer that may be infected. […] Suspecting osteomyelitis, you try to probe the bone, but the results are unclear. […] Diagnosing and managing osteomyelitis, particularly in elderly diabetic patients, can be difficult. […] What are some of the clinical signs that should make you suspect osteomyelitis? Dr. Deery says that if the ulcer has been present for more than six weeks and hasnt improved despite appropriate wound care and off-loading, suspect osteomyelitis. […] If you can probe the bone in an infected foot ulcer, there is an 85 percent chance the patient has osteomyelitis. […] It can take up to two weeks for signs of the condition to appear on an X-ray. […] The IDSA guidelines and everyone interviewed for this story say that MRI is the preferred imaging modality to confirm osteomyelitis.

• #1 Osteomyelitis Workup: Laboratory Studies, Imaging Studies, Biopsy

  https://emedicine.medscape.com/article/1348767-workup

  A complete blood count (CBC) is useful for evaluating leukocytosis and anemia. Leukocytosis is common in acute osteomyelitis before therapy. The leukocyte count rarely exceeds 15,000/L acutely and is usually normal in chronic osteomyelitis. The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level are usually increased. […] Blood cultures are positive in only 50% of cases of osteomyelitis. […] The American College of Radiology (ACR) has published imaging guidelines for the diagnosis of suspected osteomyelitis, septic arthritis, and soft-tissue infections in cases not involving the spine or the diabetic foot. […] Conventional radiography is the initial imaging study at presentation of acute osteomyelitis. […] MRI is a very useful modality in detecting osteomyelitis and gauging the success of therapy because of its high sensitivity and excellent spatial resolution.

• #1 Osteomyelitis: Making the Diagnosis – emDocs

  https://www.emdocs.net/osteomyelitis-making-diagnosis/

  Inflammatory markers including WBC, ESR, and CRP are routinely obtained for the evaluation of suspected OM. A review of the literature found three studies that reported the sensitivity of ESR between 68-90% for varying cut-off values, two that reported the sensitivity of CRP as 85% for cut-off values, and two that reported the sensitivity of WBC as 41% and 75% for cut-off values. The largest of these studies included 34 patients with confirmed OM. […] The sensitivity of MRI has been reported from 82 to 100%, and this is the diagnostic modality of choice unless bone cultures can be obtained expeditiously – the gold standard. Typically, this is not something available in the ED for this diagnosis, and admission would be warranted. […] If the provider’s suspicion of OM is high, antibiotics are often initiated immediately in the ED prior to obtaining bone and/or wound cultures. Blood cultures are frequently obtained prior to the initiation of antibiotics despite low yields. If the patient is stable and does not meet criteria for sepsis, the provider should consider delaying antibiotics until obtaining wound and/or bone cultures.

• #1 JBJI – Diagnosis of vertebral osteomyelitis

  https://jbji.copernicus.org/articles/7/23/2022/

  Inflammatory biomarkers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are the most well-studied screening tests for NVO in the setting of back pain. (Berbari et al., 2015). Both markers have been found to have a sensitivity in the range of 94%100%, particularly when used in combination (Berbari et al., 2015). […] Although MRI is the preferred imaging modality for the diagnosis of NVO, we recommend obtaining a plain radiograph of the spine as an initial test (Diehn, 2012). […] MRI is the preferred imaging modality for diagnosing NVO (Diehn, 2012). The sensitivity, specificity, and accuracy of MRI in diagnosing NVO are estimated at 97%, 92%, and 94%, respectively (Table 1; Modic et al., 1985). […] Nuclear imaging techniques have also been employed successfully to diagnose NVO (Prodi et al., 2016).

• #1 Osteomyelitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p395.html

  The differential diagnosis of osteomyelitis includes soft tissue infection, gout, Charcot arthropathy, fracture, malignancy, bursitis, osteonecrosis, sickle cell vasoocclusive pain crisis, and SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis). […] Definitive diagnosis is made with a positive culture from biopsy of the affected bony structure. […] Imaging studies (e.g., plain film radiography, magnetic resonance imaging, bone scintigraphy) demonstrating contiguous soft tissue infection or bony destruction. […] Initial laboratory evaluation should include a complete blood count, erythrocyte sedimentation rate, C-reactive protein, and blood cultures. […] Plain film radiography is the first-line evaluation of suspected osteomyelitis. […] Advanced imaging is often needed for diagnosis following plain film radiography, because 50% to 75% of the bone matrix must be destroyed before lytic changes are evident on plain radiographs. […] MRI is more readily available and avoids radiation exposure, but positron emission tomography (PET) and single-photon emission computed tomography (SPECT) can also reliably diagnose osteomyelitis.

• #1 Osteomyelitis: Diagnosis and Treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34652112/

  Osteomyelitis is usually clinically diagnosed with support from imaging and laboratory findings. […] Bone biopsy and microbial cultures offer definitive diagnosis. […] Plain film radiography should be performed as initial imaging, but sensitivity is low in the early stages of disease. […] Magnetic resonance imaging with and without contrast media has a higher sensitivity for identifying areas of bone necrosis in later stages. […] Staging based on major and minor risk factors can help stratify patients for surgical treatment. […] Antibiotics are the primary treatment option and should be tailored based on culture results and individual patient factors. […] Surgical bony debridement is often needed, and further surgical intervention may be warranted in high-risk patients or those with extensive disease. […] Diabetes mellitus and cardiovascular disease increase the overall risk of acute and chronic osteomyelitis.

• #1 Osteomyelitis: Making the Diagnosis – emDocs

  https://www.emdocs.net/osteomyelitis-making-diagnosis/

  The physical exam is of somewhat limited value versus expected when evaluating patients with suspected OM. Probing to bone of diabetic foot ulcers has been found to have a sensitivity of 66%, and a specificity of 85% in a prospective study of 76 cases. An ulcer area larger than 2 cm² makes OM more likely, while an ulcer less than 2 cm² makes it less likely. The presence or absence of inflammatory signs such as erythema, edema, or purulence does not contribute to the probability of disease. All of these findings can aid the provider in making the diagnosis, but none have sufficient sensitivity to rule out disease. […] With the limitations of physical exam in OM, plain film imaging and serum inflammatory markers are commonly obtained to aid the diagnosis. Findings suggestive of OM on radiography include cortical erosion, periosteal reaction, mixed lucency, and sclerosis. These signs may not be evident for up to 2 weeks into the infection. Sensitivity of plain radiographs (XR) has been reported between 43%-75% for OM due to diabetic foot ulcers, but may be much less for other areas of OM.

• #1 Osteomyelitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/osteomyelitis?lang=us

  Bone marrow edema is the earliest feature of acute osteomyelitis seen on MRI and can be detected as early as 1 to 2 days after the onset of infection. […] Concordant low signal T1 and high signal on fluid-sensitive sequences is the hallmark of osteomyelitis on MRI. […] Where there is discordant bone marrow signal change (i.e. high signal on fluid-sensitive sequences but normal T1 signal), the more intense the signal is on fluid-sensitive sequences is (i.e. similar to joint fluid signal), the more likely osteomyelitis is to be present or subsequently develop.

• #1 Osteomyelitis: Approach to Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2696389/

  Blood cultures should always be obtained when osteomyelitis is suspected, though they are often negative except in cases of hematogenous osteomyelitis. The gold standard for the diagnosis of osteomyelitis is bone biopsy with histopathologic examination and tissue culture. […] Several imaging modalities are useful in the evaluation of osteomyelitis. Plain radiographs are the first step in assessment as they are inexpensive and safe, and may make the diagnosis. Bone destruction and periosteal reaction are not typically seen until infection has been present for 10-21 days. […] Computed tomography (CT) and magnetic resonance imaging (MRI) can be of great value in the diagnosis and evaluation of osteomyelitis. Both modalities show anatomic detail, including cortical destruction and soft tissue extension.

• #1 Diagnosis of Acute Osteomyelitis | CDA-AMC

  https://www.cda-amc.ca/diagnosis-acute-osteomyelitis

  The most common method of diagnosing osteomyelitis involves sampling the infected tissue either through bone biopsy or surgery and having laboratory procedures to confirm the existence of bacterial involvement. This is a relatively invasive and costly procedure and there has been an effort to explore alternate non-invasive techniques, including diagnostic imaging, for identifying the presence of infection. Nuclear bone scintigraphy is a frequently performed nuclear medicine procedure for the detection of bone disorders. […] Bone scintigraphy is a common method used to diagnose acute osteomyelitis. Most bone scintigraphs are conducted with the administration of methylene diphosphonate labelled with technetium-99m (99mTc-MDP). After the radioisotope has been injected into the blood, it accumulates in the bone. Imaging usually occurs in three phases the first phase (called the angiographic phase) is obtained at the time of administration of 99mTc-MDP; the second phase, or blood pool phase, is obtained in the first few minutes after injection to assess alterations in vasculature due to inflammation; and the third phase is obtained three to six hours after injection, to look at bone uptake.

• #1 Abscess pulsatility: a sonographic sign of osteomyelitis | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-023-00339-0

  Early diagnosis and aggressive treatment of acute osteomyelitis may improve prognosis and prevent further complications. Sonography is useful in the evaluation of osteomyelitis. It can demonstrate early signs of inflammation, such as soft tissue changes near the affected bone, periosteal thickening, periosteal elevation, and subperiosteal abscess. […] Point-of-care ultrasound demonstrated a bidirectional flow of fluid through a disruption in the bone cortex visualized on greyscale imaging and confirmed with color and spectral Doppler. The patient was diagnosed with osteomyelitis and treated with antibiotics and incision and drainage by orthopedic surgery. […] The sonographic finding of pulsatility in an abscess near bone should raise the concern for communication with the medullary cavity.

• #1 Osteomyelitis: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/orthopedics/columbia-orthopedics/osteomyelitis/treatment

  X-ray – Also known as plain films, this test uses invisible electromagnetic energy beams (X-rays) to create images of the bones. This can provide a general assessment of bone anatomy and help detect bone damage. However, X-rays may not show damage until osteomyelitis has been present in the body for several weeks. […] Biopsy Bone biopsies are often used to diagnose osteomyelitis. More specifically, a biopsy can determine what kind of bacteria or fungi has caused the infection. Open biopsies necessitate anesthesia and surgery. In some cases, a surgeon can instead insert a long needle through the skin and into the bone. This requires local anesthetic.

• #1 Osteomyelitis

  https://www.nhs.uk/conditions/osteomyelitis/

  Osteomyelitis is a painful bone infection. It usually goes away if treated early with antibiotics. It can cause serious long-term problems if it’s not treated. […] The GP will examine the area and may do some tests to find out if you have a bone infection. […] You might need a blood test, or to go to hospital for: an X-ray, CT scan or MRI scan; a biopsy, where a small sample of fluid is taken from the bone and sent for testing. […] Osteomyelitis is treated with antibiotics. You may need treatment in hospital, or you might be able to take antibiotics at home. […] You’ll usually take antibiotics for 4 to 6 weeks. If you have a severe infection, you may need to take them for up to 12 weeks. It’s important to finish a course of antibiotics even if you start to feel better. […] If the infection is treated quickly (within 3 to 5 days of it starting), it often clears up completely.

• #1 Osteomyelitis: Symptoms, Causes, and Treatment

  https://www.webmd.com/diabetes/osteomyeltis-treatment-diagnosis-symptoms

  Figuring out if a person has osteomyelitis is the first step in treatment. It’s also surprisingly difficult. Doctors rely on X-rays, blood tests, MRI, and bone scans to get a picture of what’s going on. A bone biopsy helps determine the type of organism, typically bacteria, causing the infection so the right medication can be prescribed. […] Treatment focuses on stopping infection in its tracks and preserving as much function as possible. Most people with osteomyelitis are treated with antibiotics, surgery, or both. […] The sooner you treat osteomyelitis, the better. In cases of acute osteomyelitis, early treatment prevents the condition from becoming a chronic problem that requires ongoing treatment. Besides the pain and inconvenience of repeated infections, getting osteomyelitis under control early provides the best chance for recovery.

• #1 Osteomyelitis Differential Diagnoses

  https://emedicine.medscape.com/article/1348767-differential

  Clinical suspicion, presence of deep bony tenderness, local signs of inflammation, and symptoms of acute clinical infection are helpful in initiating a diagnosis of acute osteomyelitis where radiologic signs may be absent or minimal and time is of the essence. […] Laboratory studies and synovial fluid analysis are helpful for diagnosis. […] Osteomyelitis also tends to have clinical symptoms (eg, pain, swelling, and fever) developing over a longer time course than a vaso-occlusive crisis.

• #1 IDSA 2015 Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults

  https://www.idsociety.org/practice-guideline/vertebral-osteomyelitis/

  Native vertebral osteomyelitis (NVO) in adults is often the result of hematogenous seeding of the adjacent disc space from a distant focus, as the disc is avascular. The diagnosis of NVO can often be delayed several months and may initially be misdiagnosed and mismanaged as a degenerative process. NVO is typically diagnosed in the setting of recalcitrant back pain unresponsive to conservative measures and elevated inflammatory markers with or without fever. […] Plain radiographs of the spine are not sensitive for the early diagnosis of NVO. Magnetic resonance imaging (MRI) of the spine is often required to establish the diagnosis. […] An image-guided or intraoperative aspiration or biopsy of a disc space or vertebral endplate sample submitted for microbiologic and pathologic examination often establishes the microbiologic or pathologic diagnosis of NVO.

• #1 IDSA 2015 Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults

  https://www.idsociety.org/practice-guideline/vertebral-osteomyelitis/

  The majority of patients are cured with a 6-week course of antimicrobial therapy, but some patients may need surgical debridement and/or spinal stabilization during or after a course of antimicrobial therapy. […] Most patients can be followed symptomatically and by monitoring laboratory parameters such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). […] We recommend performing a pertinent medical and motor/sensory neurologic examination in patients with suspected NVO. […] We recommend obtaining bacterial (aerobic and anaerobic) blood cultures (2 sets) and baseline ESR and CRP in all patients with suspected NVO. […] We recommend a spine MRI in patients with suspected NVO. […] We recommend an image-guided aspiration biopsy in patients with suspected NVO when a microbiologic diagnosis for a known associated organism has not been established by blood cultures or serologic tests.

• #1 PIDS/IDSA Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics

  https://www.idsociety.org/practice-guideline/bone-and-joint-infections—osteomyelitis/

  In children with suspected AHO, we recommend performing blood culture prior to the administration of antimicrobial therapy (strong recommendation and moderate certainty of evidence). […] In children with suspected AHO, we suggest performing a serum C-reactive protein (CRP) on initial evaluation (conditional recommendation and very low certainty of evidence). Comment: Serum CRP has a low accuracy to establish the diagnosis of AHO, but in situations where AHO is confirmed, the serum CRP performed on initial evaluation can serve as the baseline value for sequential monitoring. […] In children with suspected AHO, we recommend obtaining plain radiography of the potentially infected bone(s) rather than not performing plain radiographs (strong recommendation and moderate certainty of evidence). Comment: Despite the low sensitivity of plain radiography for detecting AHO on initial presentation, other important diagnoses may be ruled out by this simple, quick, safe, and relatively inexpensive imaging test.

• #1 Diagnosis and Treatment of Osteomyelitis in Chronic Wounds

  https://www.thewoundpros.com/post/diagnosis-and-treatment-of-osteomyelitis-in-chronic-wounds

  Osteomyelitis is inflammation of the bone due to infection with pathogenic microorganisms. […] Most cases of osteomyelitis are caused by the bacteria Staphylococcus aureus however, other causative bacteria have been isolated from patients confirmed to have the disease. […] The primary cause of osteomyelitis in a person with a chronic wound is hematogenous spread from the wound site through the bloodstream to the bones. […] Poor healing, chronic wounds are highly susceptible to the development of wound site bacterial colonization, and subsequent dissemination to nearby bones. […] Unfortunately, some cases of osteomyelitis might have vague symptoms or no symptoms at all. […] Bone involvement in osteomyelitis results from bacterial dissemination from a chronic wound or new trauma to the wound site.

• #1

  https://austinpublishinggroup.com/dental-disorders/fulltext/jdod-v3-id1066.php

  To review the contemporary literature on the various types of osteomyelitis of the jaw and list treatment options, diagnostic measures, opinions and speculations concerning OM of the jaws. […] The current understanding of the predisposing factors and developmental phases of osteomyelitis of the jaw is insufficient. A widely diagnostic consensus is needed if reported data are to be used in meta-analyses. […] OM of the jaw has proved a challenging condition to effectively diagnose, treat, and cure. As previously mentioned, there are multiple diagnoses for different manifestations of OM of the jaw, some of which are sub classifications, other may be the same condition in a different stage or a different expression. […] Many different diagnostic techniques have been proven to be useful, but so far the agreement among many authors is that the final diagnosis should be based on the following parameters: (1) the clinical presentation and history of the patient, (2) imaging techniques, (3) culturing, and (4) histologic analysis.

• #1 Chronic recurrent multifocal osteomyelitis (CRMO) – advancing the diagnosis | Pediatric Rheumatology | Full Text

  https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-016-0109-1

  Chronic recurrent multifocal osteomyelitis (CRMO) is a little known inflammatory bone disease occurring primarily in children and adolescents. Delays in referral and diagnosis may lead to prolonged courses of antibiotics with in-patient care, unnecessary radiation exposure from multiple plain radiographs or bone scans and repeated surgery including bone biopsies. […] The aim of the study was to examine the features of the cohort, to examine the length of time to diagnosis and to explore the criteria used for diagnosis with and without biopsy. […] The data suggest that increasing knowledge of this condition may shorten time to diagnosis. Use of the Bristol diagnostic criteria by an experienced clinician may obviate the need for biopsy in some patients. […] The diagnosis of CRMO is made by exclusion of other diseases, and commonly requires a bone biopsy in order to exclude infection, neoplasia or langerhans cell histiocytosis.

• #1 Value of Diagnostic Tools in the Diagnosis of Osteomyelitis: Pilot Study to Establish an Osteomyelitis Score

  https://www.mdpi.com/2077-0383/12/9/3057

  Thus, the aim of this study was to prospectively evaluate the value of diagnostic means in the diagnosis of OM and to develop a grading system to facilitate and standardize the diagnosis of OM in the limbs. […] The WBC, CRP, MRI, microbiologic, and histopathologic results were analyzed regarding their diagnostic value to predict the presence of OM between patients with and without a subsequent OM. […] The OM score includes MRI, microbiology, and histopathology. […] By means of the OM score, the presence and absence of OM could be correctly diagnosed in 14 patients (93.3%) and treatment could be derived for all patients according to the score. […] The strengths and advantages of the proposed score are that it is easy to assess and that only those diagnostic tools have been included that are ubiquitously available and, thus, feasible for any surgeon. […] The correct administration and application of further diagnostic tools, specifically MRI, microbiological and histopathological tests, and their precise interpretation, is essential to a proper diagnosis of OM.

• #1

  https://www.orthobullets.com/trauma/1057/osteomyelitis–adult

  Osteomyelitis is the infection of bone characterized by progressive inflammatory destruction and apposition of new bone. […] Diagnosis requires careful assessment of radiographs, MRI and determining the organism via biopsy and cultures. […] Treatment is often a combination of culture-directed antibiotics and surgical debridement of nonviable tissue. […] Imaging findings lag behind by 2 weeks. […] MRI assists in the diagnosis and surgical planning. […] MRI is the best test for diagnosing early osteomyelitis and localizing infection. […] Sensitivity and specificity is variable. […] If negative, rules out osteomyelitis. […] If positive, may overestimate the extent of osteomyelitis. […] Blood cultures are often negative, but may be used to guide therapy for hematogenous osteomyelitis.

• #1 Chronic recurrent multifocal osteomyelitis (CRMO) – advancing the diagnosis | Pediatric Rheumatology | Full Text

  https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-016-0109-1

  Our findings suggest that raising the awareness of CRMO may lead to earlier diagnosis. The protracted interval of 15 months (median) between symptom onset and diagnosis is well recognised and is partially explained by the lack of specific clinical, laboratory and imaging findings, and the difficulty in distinguishing the inflammation from infection. […] Delay in diagnosis can lead to prolonged admissions for intravenous antibiotics (sometimes multiple admissions), and multiple biopsies which, it can be argued, are rarely necessary for the diagnosis of CRMO. […] Using these criteria for diagnosis provides a framework for avoiding biopsy in children with typical disease; however, these criteria cannot be validated by this retrospective audit as the clinicians and/or radiologist may have been aware of a biopsy report when making the diagnosis.

• #2 Osteomyelitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteomyelitis/diagnosis-treatment/drc-20375917

  Your healthcare professional may feel the area around the affected bone for tenderness, swelling or warmth. If you have a foot sore, your healthcare professional may use a dull probe to see how close the sore is to the bone under it. […] You also might have tests to diagnose osteomyelitis and to find out which germ is causing the infection. Tests may include blood tests, imaging tests and a bone biopsy. […] Blood tests can show high levels of white blood cells and other markers in the blood that may mean that your body is fighting an infection. Blood tests also may show which germs caused the infection. […] No blood test can tell whether you have osteomyelitis. But blood tests can help your healthcare professional decide what other tests and procedures you may need. […] X-rays can show damage to a bone. But the damage may not show on X-rays until osteomyelitis has been there for weeks. You may need more-detailed imaging tests if your infection is more recent. […] A bone biopsy can show what type of germ has infected your bone. Knowing the type of germ helps your healthcare professional choose an antibiotic that works well for the type of infection you have.

• #2 Diagnosing Osteomyelitis | NYU Langone Health

  https://nyulangone.org/conditions/osteomyelitis/diagnosis

  NYU Langone physicians are experienced in diagnosing bone infections, also known as osteomyelitis. […] To diagnose a bone infection, doctors first perform a physical exam, looking for any open wounds or areas of tenderness, swelling, and redness. […] Your doctor may also order tests to look for the presence of bacteria and assess the extent of the condition. […] Doctors may use blood tests to determine whether you have an infection. The only way to determine what type of bacteria is causing an infection is with a tissue or fluid sample culture. […] A CT scan may reveal bone damage caused by an infection. […] Areas of bone growth or repair show up as bright spots on the image. This can indicate an infection. If the scan is positive, further testing is required. […] Doctors may perform a tissue culture to determine the type of bacteria or germ causing the infection. […] After identifying a bone infection through imaging studies, your doctor may biopsy the affected area to determine which bacteria are involved and to choose the best course of treatment.

• #2 Osteomyelitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/osteomyelitis/

  Osteomyelitis can be either acute or chronic and manifests with signs of local inflammation, including swelling, pain, redness, and warmth. […] Diagnosis is supported via laboratory tests, imaging, and/or biopsy. […] In stable patients, defer antibiotics until blood cultures and/or bone biopsy have been taken. […] Bone biopsy with cultures is the confirmatory test for osteomyelitis and should be performed unless there are characteristic imaging features of osteomyelitis and positive blood cultures. […] The following recommendations are for nonvertebral osteomyelitis; diagnostics for vertebral osteomyelitis are detailed separately in Spinal infections. […] Signs of sepsis present: Start management of sepsis without waiting for diagnostic test results. […] Imaging findings and blood cultures inconclusive: Consider bone biopsy with cultures to confirm the diagnosis. […] A positive probe-to-bone test is strongly suggestive of osteomyelitis, especially in diabetic patients with risk factors for osteomyelitis. […] The diagnosis and management of vertebral osteomyelitis are described in Spinal infections.

• #2 Osteomyelitis: Symptoms, Treatment, Causes, and Diagnosis

  https://www.ganeshdiagnostic.com/blog/osteomyelitis-symptoms-treatment-causes-and-diagnosis

  Osteomyelitis was first considered as deadly disease, because of its long therapies and the results were not even satisfying. […] The complete blood count will present with moderate leukocytosis. […] The degree of bone alteration requires 4-8 days, after the onset of acute osteomyelitis. […] MRI( Magnetic resonance imaging) It is the most effective way of detecting osteomyelitis as it is able to identify any infection of bone within 3-5 days of disease onset. […] The change in the bone composition during osteomyelitis can be seen up to 3 to 4 days for onset of disease.

• #2 JBJI – Diagnosis of vertebral osteomyelitis

  https://jbji.copernicus.org/articles/7/23/2022/

  Inflammatory biomarkers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are the most well-studied screening tests for NVO in the setting of back pain. (Berbari et al., 2015). Both markers have been found to have a sensitivity in the range of 94%100%, particularly when used in combination (Berbari et al., 2015). […] Although MRI is the preferred imaging modality for the diagnosis of NVO, we recommend obtaining a plain radiograph of the spine as an initial test (Diehn, 2012). […] MRI is the preferred imaging modality for diagnosing NVO (Diehn, 2012). The sensitivity, specificity, and accuracy of MRI in diagnosing NVO are estimated at 97%, 92%, and 94%, respectively (Table 1; Modic et al., 1985). […] Nuclear imaging techniques have also been employed successfully to diagnose NVO (Prodi et al., 2016).

• #2 Osteomyelitis: Approach to Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2696389/

  Blood cultures should always be obtained when osteomyelitis is suspected, though they are often negative except in cases of hematogenous osteomyelitis. The gold standard for the diagnosis of osteomyelitis is bone biopsy with histopathologic examination and tissue culture. […] Several imaging modalities are useful in the evaluation of osteomyelitis. Plain radiographs are the first step in assessment as they are inexpensive and safe, and may make the diagnosis. Bone destruction and periosteal reaction are not typically seen until infection has been present for 10-21 days. […] Computed tomography (CT) and magnetic resonance imaging (MRI) can be of great value in the diagnosis and evaluation of osteomyelitis. Both modalities show anatomic detail, including cortical destruction and soft tissue extension.

• #2 Osteomyelitis: Diagnosis and Treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34652112/

  Osteomyelitis is usually clinically diagnosed with support from imaging and laboratory findings. […] Bone biopsy and microbial cultures offer definitive diagnosis. […] Plain film radiography should be performed as initial imaging, but sensitivity is low in the early stages of disease. […] Magnetic resonance imaging with and without contrast media has a higher sensitivity for identifying areas of bone necrosis in later stages. […] Staging based on major and minor risk factors can help stratify patients for surgical treatment. […] Antibiotics are the primary treatment option and should be tailored based on culture results and individual patient factors. […] Surgical bony debridement is often needed, and further surgical intervention may be warranted in high-risk patients or those with extensive disease. […] Diabetes mellitus and cardiovascular disease increase the overall risk of acute and chronic osteomyelitis.

• #2 Role of MRI in the diagnosis and treatment of osteomyelitis in pediatric patients

  https://www.wjgnet.com/1949-8470/full/v6/i8/530.htm

  MRI is both sensitive for the detection of early osteomyelitis and can also accurately depict the extent of disease as well as any associated abscess or soft-tissue extension without the risks associated with radiation exposure. […] MRI has assumed a greater role in the evaluation of osteomyelitis with the increase in musculoskeletal infections caused by methicillin-resistant Staphylococcus aureus which have unique imaging features that are well-demonstrated with MRI. […] MRI is the imaging modality of choice for the detection of osteomyelitis and associated infection of the extraosseous soft tissues.

• #2 The imaging of osteomyelitis – Lee – Quantitative Imaging in Medicine and Surgery

  https://qims.amegroups.org/article/view/9839/html

  Osteomyelitis is an important cause of morbidity and mortality in children and adults. Imaging plays a crucial role in establishing a timely diagnosis and guiding early management, with the aim of reducing long-term complications. […] For these reasons, imaging plays an integral role in establishing the diagnosis of osteomyelitis and characterising the extent of disease spread. The importance of imaging goes beyond making the initial diagnosis as radiologists are able to perform image-guided abscess aspirations and bone biopsies to direct further management, and follow-up scans are often required during the course of treatment to ensure resolution of infection. […] This article provides an overview of the imaging of osteomyelitis, focusing on the correlation between radiological features and the underlying pathological processes.

• #2 Diagnosis of Acute Osteomyelitis | CDA-AMC

  https://www.cda-amc.ca/diagnosis-acute-osteomyelitis

  The review of the current literature yielded two meta-analyses, one systematic review, and two primary studies that evaluated various comparators in the diagnosis of osteomyelitis, including bone scintigraphy. The results of studies that evaluated various comparators in the diagnosis of osteomyelitis including bone scintigraphy are summarized in the table: Test Sensitivity (%) Specificity (%) Bone scan 81 to 90.3 28.0 to 84.5 Bone biopsy Reference Standard Reference Standard MRI 88.2 to 90.1 73.9 to 98 18FDG-PET 94.1 87.3 Leukocyte scan 74 to 89 68 to 83.8 […] Bone scintigraphy has been demonstrated to be the best predictor of osteomyelitis and MRI results are secondary to it. CT would be the next preferred test, with U/S yielding the lowest diagnostic odds ratio (DOR).

• #2 Abscess pulsatility: a sonographic sign of osteomyelitis | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-023-00339-0

  Early detection, diagnosis, and treatment is essential in minimizing complications such as systemic infection, permanent bone damage, and loss of function. […] Point-of-care ultrasound use was pivotal in this case, enabling the treating team to further characterize the extent of the patients soft tissue infection and reach the diagnosis of osteomyelitis. […] The presence of pulsatility in this case, which could represent either blood flow or pseudoflow, drew the ultrasound operator’s eye to the cortical defect, raising the concern for bony involvement and the need for CT imaging and surgical consultation. […] Several studies have demonstrated sonography’s ability to detect early inflammatory changes in acute osteomyelitis when correlated with clinical findings. […] Sonographic changes suggesting osteomyelitis can be visualized within 13 days from the onset of symptoms. […] The ability to detect bony involvement in an abscess on point-of-care ultrasound allows the clinician to proceed with appropriate management of osteomyelitis and avoid performing an incision and drainage at the bedside that should occur in the operating room.

• #2 Diagnosis and Management of Osteomyelitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1101/p1027.html

  The incidence of chronic osteomyelitis is increasing because of the prevalence of predisposing conditions such as diabetes mellitus and peripheral vascular disease. The increased availability of sensitive imaging tests, such as magnetic resonance imaging and bone scintigraphy, has improved diagnostic accuracy and the ability to characterize the infection. […] The preferred diagnostic criterion for osteomyelitis is a positive bacterial culture from bone biopsy in the setting of bone necrosis. […] The diagnosis of osteomyelitis in adults can be difficult. A high index of clinical suspicion is required, along with recognition of clinical symptoms and supportive laboratory and imaging studies. […] Microbial cultures are essential in the diagnosis and treatment of osteomyelitis. The preferred diagnostic criteria for osteomyelitis are a positive culture from bone biopsy and histopathology consistent with necrosis.

• #2

  https://www.orthobullets.com/trauma/1057/osteomyelitis–adult

  Culture of bone is the gold-standard for guiding antibiotic therapy. […] Antibiotics should be tailored to a specific organism, preferably after a bone biopsy is obtained. […] Chronic suppressive antibiotics may be useful in patients who are immunocompromised or in whom surgery is not feasible. […] Irrigation and debridement followed by organism specific antibiotics is indicated for acute osteomyelitis that fails to improve on IV antibiotics. […] Sequestrum must be eliminated from the body, or infection is likely to recur. […] When combined with postoperative antibiotics tailored to a specific organism, treatment is often successful. […] Despite surgical debridement and long-term antibiotics, the recurrence rate of chronic osteomyelitis in adults is 30%.

• #2 Osteomyelitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/354

  Osteomyelitis should be suspected in those with a history of open fracture, recent orthopaedic surgery, or a discharging sinus; in unwell children with a limp, or in immunocompromised patients. […] Suspect chronic osteomyelitis most commonly in adults with a history of open fracture, previous orthopaedic surgery, or a discharging sinus. […] Suggestive clinical features include fever, bone pain, and reduced mobility; local erythema, tenderness, warmth, and swelling; and reduced range of movement. […] Consider native vertebral osteomyelitis in a patient with new back pain and systemic symptoms. […] Request plain x-rays to screen for acute and chronic osteomyelitis. […] Magnetic resonance imaging (MRI) is the imaging modality with greatest sensitivity for diagnosing osteomyelitis. […] The diagnosis should be confirmed by culture obtained from biopsy of the involved bone. There is limited value in surface or sinus swabs.

• #2 JBJI – Diagnosis of vertebral osteomyelitis

  https://jbji.copernicus.org/articles/7/23/2022/

  Optimal management relies on the isolation of the causative organism. The initial step is collecting bacterial blood cultures, which are positive in approximately 58% of cases (range 30%78%) (Mylona et al., 2009; Zimmerli, 2010). […] If the initial biopsy is nondiagnostic, a second percutaneous biopsy may be warranted, although the exact increased yield is unclear (Gras et al., 2014). A repeat biopsy should be delayed at least 3d after the initial biopsy, at which time the majority of positive cultures from the first should have resulted (Yeh et al., 2020). […] The role of additional imaging, careful evaluation of images, and histopathology is invaluable in these cases (Morales, 2018).

• #2 Osteomyelitis: Symptoms, Causes, and Treatment

  https://patient.info/bones-joints-muscles/osteomyelitis-leaflet

  An antibiotic is usually started as soon as possible. The initial antibiotic chosen is one that is likely to kill the germs (bacteria) which commonly cause osteomyelitis. However, the antibiotic is sometimes changed to a different one when the results of the tests confirm which bacterium is causing the infection. […] If the osteomyelitis infection is treated promptly, there is a good chance of a complete cure. The best outcome occurs if treatment is started within 3-5 days of the beginning of infection.

• #2 Delayed Diagnosis or Treatment of Osteomyelitissocial-media-facebook-darksocial-media-Instagram-darksocial-media-Linkedin-darksocial-media-Youtube-dark

  https://finzfirm.com/blog/delayed-diagnosis-or-treatment-of-osteomyelitis/

  Osteomyelitis is an infection of the bone, frequently caused by Staphylococcus aureus but also associated with other bacteria. Osteomyelitis can occur in any individual, but is most commonly associated with patients who have undergone certain treatments or suffered certain diseases. Osteomyelitis is more common after a joint replacement or after a wound becomes infected. […] The symptoms for Osteomyelitis include fever, pain, and swelling, so a differential diagnosis requires an evaluation of the health history of the patient. Recognizing the disease risk factors as well as the likelihood of a bone infection following an open fracture or surgical procedure drastically increases the likelihood of the disease being diagnosed and treated in time. […] Failing to properly identify and treat Osteomyelitis can have significant side effects, including osteonecrosis (bone death) and arthritis, both linked to increased risk of amputation and severe pain. Severe pain can leave an individual unable to work or perform basic daily living skills. In some cases, patients have died from the infection, despite the fact that in most cases this disease can be treated with intravenous antibiotics.

• #2 Osteomyelitis Differential Diagnoses

  https://emedicine.medscape.com/article/1348767-differential

  Clinical suspicion, presence of deep bony tenderness, local signs of inflammation, and symptoms of acute clinical infection are helpful in initiating a diagnosis of acute osteomyelitis where radiologic signs may be absent or minimal and time is of the essence. […] Laboratory studies and synovial fluid analysis are helpful for diagnosis. […] Osteomyelitis also tends to have clinical symptoms (eg, pain, swelling, and fever) developing over a longer time course than a vaso-occlusive crisis.

• #2 IDSA 2015 Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults

  https://www.idsociety.org/practice-guideline/vertebral-osteomyelitis/

  The majority of patients are cured with a 6-week course of antimicrobial therapy, but some patients may need surgical debridement and/or spinal stabilization during or after a course of antimicrobial therapy. […] Most patients can be followed symptomatically and by monitoring laboratory parameters such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). […] We recommend performing a pertinent medical and motor/sensory neurologic examination in patients with suspected NVO. […] We recommend obtaining bacterial (aerobic and anaerobic) blood cultures (2 sets) and baseline ESR and CRP in all patients with suspected NVO. […] We recommend a spine MRI in patients with suspected NVO. […] We recommend an image-guided aspiration biopsy in patients with suspected NVO when a microbiologic diagnosis for a known associated organism has not been established by blood cultures or serologic tests.

• #2 IDSA 2015 Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults

  https://www.idsociety.org/practice-guideline/vertebral-osteomyelitis/

  We recommend a total duration of 6 weeks of parenteral or highly bioavailable oral antimicrobial therapy for most patients with bacterial NVO. […] We recommend surgical intervention in patients with progressive neurologic deficits, progressive deformity, and spinal instability with or without pain despite adequate antimicrobial therapy. […] We suggest monitoring systemic inflammatory markers (ESR and or CRP) in patients with NVO after approximately 4 weeks of antimicrobial therapy, in conjunction with a clinical assessment. […] In patients with NVO and suspected treatment failure, we suggest obtaining markers of systemic inflammation (ESR and CRP). Unchanged or increasing values after 4 weeks of treatment should increase suspicion for treatment failure.

• #2 PIDS/IDSA Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics

  https://www.idsociety.org/practice-guideline/bone-and-joint-infections—osteomyelitis/

  In children with suspected AHO requiring further imaging studies to confirm the diagnosis, we suggest magnetic resonance imaging (MRI) rather than scintigraphy (bone scan), computerized tomographic (CT) scan, or ultrasound (US) (conditional recommendation and very low certainty of evidence). […] In children with suspected AHO, we suggest performing invasive diagnostic procedures to collect aspirates and/or biopsy specimens of bone and/or associated purulent fluid collections for routine microbiological studies (aerobic bacteriologic culture and Gram stain) rather than only performing noninvasive diagnostic tests (conditional recommendation and moderate certainty of evidence). […] In children with presumed AHO who are ill-appearing or have rapidly progressive infection, we recommend starting empiric antimicrobial therapy immediately rather than withholding antibiotics until invasive diagnostic procedures are performed (strong recommendation and moderate certainty of evidence).

• #2 Strategies to make a definitive diagnosis of osteomyelitis – Today’s Hospitalist

  https://todayshospitalist.com/Strategies-to-make-a-definitive-diagnosis-of-osteomyelitis/

  The elderly patient presents with a foot ulcer that may be infected. […] Suspecting osteomyelitis, you try to probe the bone, but the results are unclear. […] Diagnosing and managing osteomyelitis, particularly in elderly diabetic patients, can be difficult. […] What are some of the clinical signs that should make you suspect osteomyelitis? Dr. Deery says that if the ulcer has been present for more than six weeks and hasnt improved despite appropriate wound care and off-loading, suspect osteomyelitis. […] If you can probe the bone in an infected foot ulcer, there is an 85 percent chance the patient has osteomyelitis. […] It can take up to two weeks for signs of the condition to appear on an X-ray. […] The IDSA guidelines and everyone interviewed for this story say that MRI is the preferred imaging modality to confirm osteomyelitis.

• #2

  https://link.springer.com/article/10.1007/s12019-000-0017-6

  The diagnosis and therapy of osteomyelitis remains difficult despite recent advances. […] Clinical decision making is also difficult because of considerable variations in the types of disease observed and the lack of large comparative trials studying the variety of approaches.

• #2 Chronic recurrent multifocal osteomyelitis (CRMO) – advancing the diagnosis | Pediatric Rheumatology | Full Text

  https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-016-0109-1

  Our findings suggest that raising the awareness of CRMO may lead to earlier diagnosis. The protracted interval of 15 months (median) between symptom onset and diagnosis is well recognised and is partially explained by the lack of specific clinical, laboratory and imaging findings, and the difficulty in distinguishing the inflammation from infection. […] Delay in diagnosis can lead to prolonged admissions for intravenous antibiotics (sometimes multiple admissions), and multiple biopsies which, it can be argued, are rarely necessary for the diagnosis of CRMO. […] Using these criteria for diagnosis provides a framework for avoiding biopsy in children with typical disease; however, these criteria cannot be validated by this retrospective audit as the clinicians and/or radiologist may have been aware of a biopsy report when making the diagnosis.

• #2 Osteomyelitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/osteomyelitis?lang=us

  The pathological diagnosis of osteomyelitis requires a reliable tissue sample from which bacteria are isolated, along with histological findings of inflammatory cells and osteonecrosis. […] Given low culture yields (~35%), pathological testing often results in false-negative results. Osteomyelitis can be diagnosed on MRI in cases of suspected infection where there are concordant bone marrow signal changes of low T1 signal, high signal on fluid-weighted sequences, and post-contrast enhancement. […] The phrase „high likelihood of osteomyelitis” is recommended where there is bone marrow high signal on fluid-weight sequences adjacent to an ulcer, abscess, or sinus tract, no matter the T1 signal intensity. […] MRI has the highest accuracy to detect osteomyelitis with a sensitivity of 90% and specificity of ~80%.

• #3 Strategies to make a definitive diagnosis of osteomyelitis – Today’s Hospitalist

  https://todayshospitalist.com/Strategies-to-make-a-definitive-diagnosis-of-osteomyelitis/

  The elderly patient presents with a foot ulcer that may be infected. […] Suspecting osteomyelitis, you try to probe the bone, but the results are unclear. […] Diagnosing and managing osteomyelitis, particularly in elderly diabetic patients, can be difficult. […] What are some of the clinical signs that should make you suspect osteomyelitis? Dr. Deery says that if the ulcer has been present for more than six weeks and hasnt improved despite appropriate wound care and off-loading, suspect osteomyelitis. […] If you can probe the bone in an infected foot ulcer, there is an 85 percent chance the patient has osteomyelitis. […] It can take up to two weeks for signs of the condition to appear on an X-ray. […] The IDSA guidelines and everyone interviewed for this story say that MRI is the preferred imaging modality to confirm osteomyelitis.

Zobacz więcej