Osteomyelitis hematogenous

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 epidemiology of osteomyelitis has been changing over the past several decades.6 The incidence of acute hematogenous osteomyelitis, which is most often seen in children, has been declining.6,7 In contrast, the frequency of contiguous osteomyelitis has been increasing. This trend may be related to... 

The clinical presentation of osteomyelitis may vary depending on route and duration of infection, as well as patient-specific factors such as infection site, age, and comorbidities. In hematogenous osteomyelitis, the patient typically experiences systemic and localized signs and symptoms.3 4 7 12 13 In comparison, patients with chronic infection typically present with only localized signs and symptoms.4 6 A cardinal sign of chronic osteomyelitis is the formation of sinus tracts with purulent drainage.2,3,6... 

Blood cultures maybe positive in patients with hematogenous osteomyelitis... 

Steer AC, Carapetis JR. Acute hematogenous osteomyelitis in children recognition and management. Pediatr Drugs 2004 6 333-346. 

Streptococci and staphylococci Serious respiratory tract infections serious skin and soft tissue infections septicemia (parenteral only) acute staphylococcal hematogenous osteomyelitis (parenteral only). 

The most common cause of osteomyelitis (particularly that acquired by hematogenous spread) and infectious arthritis is Staphylococcus aureus. 

Hematogenous osteomyelitis is described classically as a disease of children because most cases occur in patients younger than 16 years of age. Table 116-1 summarizes the primary characteristics of osteomyelitis. Less commonly, these infections occur in adults. One exception, vertebral osteomyelitis, involves the vertebrae and occurs most frequently in patients older than 50 years of age. 

In addition to these anatomic and functional features, there is some evidence that trauma is associated with developing an infection in specific bones. Children who develop hematogenous osteomyelitis may report some type of trauma as an etiologic event. Animal data also indicate that traumatized bone is more likely to become infected than normal bone. 

In contrast to hematogenous osteomyelitis, which occurs most commonly in children, contiguous-spread osteomyelitis occurs most commonly in patients older than age 50. Most likely this is so be-canse important predisposing factors, such as hip fractures, are more common in this age group. 

The clinical presentation of acute hematogenous osteomyelitis is summarized in Table 116-3. Although neonatal hematogenous... 

If a patient with hematogenous osteomyelitis does not respond by having a decrease in fever, local swelling, redness, and pain following the initiation of adequate antibiotic therapy, the patient should undergo surgical debridement of the infected area. It is important to emphasize the priority of starting antibiotics immediately after the cultures have been obtained. No treatment failures have been reported when injectable antibiotics were started within 48 hours of the onset of symptoms in children with osteomyelitis. 

Song KM, Sloboda JF. Acute hematogenous osteomyelitis in children. J Am Acad Orthop Surg 2001 9 166-175. 

Hamdy RC, Lawton L, Carey T, et al. Subacute hematogenous osteomyelitis Are biopsy and surgery always indicated J Pediatr Orthop 1996 16 220-223. 

Le Saux N, Howard A, Barrowman NJ, et al. Shorter courses of parenteral antibiotic therapy do not appear to influence response rates for children with acute hematogenous osteomyelitis A systematic review. BMC Infect Dis 2002 2 16-24. 

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