Osteomyelitis

Presented by: Group A5 and A7

 Case Scenario:
Edwin Vazquez, a 61-year-old man was involved in a motor vehicle
accident and sustained an open tibia fracture, and was treated with
intramedullary nailing. For the past 4 years, he continued to have
pain and persistent discharge from a sinus over his shin. He
ambulated with crutches and refrained from putting weight on the
extremity.
 Definition
Osteomyelitis can be broken down into “osteo” meaning bone, and “myelitis”,
meaning inflammation of the fatty tissues within the bone.

Osteomyelitis is inflammation of the bone caused by an infecting organism. Although

bone is normally resistant to bacterial colonization, it can get infected in multiple
ways. The infecting organism may reach bone through blood or events such as
trauma, surgery, the presence of foreign bodies, or the placement of prostheses that
disrupt bony integrity and predispose to the onset of bone infection. When
prosthetic joints are associated with infection, microorganisms typically grow in
biofilm, which protects bacteria from antimicrobial treatment and the host immune
response.
 Important Terms
• Bacterial Colonization
- Colonization is the presence of bacteria on a body surface without causing
disease in the person.

• Biofirms
- Biofilm is a complex structure of microbiome having different bacterial
colonies or single type of cells in a group; adhere to the surface.
Causes
By: Alipolo
 Causes

Most cases of osteomyelitis are caused by

staphylococcus bacteria, types of germs commonly
found on the skin or in the nose of even healthy
individuals. Germs can enter a bone in a variety of
ways, including: The bloodstream.
RISK FACTORS
By: Amsaina Aman
 RISK FACTORS
• Recent injury or orthopedic surgery

• Circulation disorders

• Problems requiring intravenous lines or catheters

• Conditions that impair the immune system

•Illicit Drugs

• Diabetes

• Infants

• Elderly
 SIGNS &
SYMPTOMS
Monaliza Zaidon & Norjeina Mendoza
 Signs and symptoms
• Pain at the infection site
• Fever and chills
• Redness in the infected area
• Irritability or generally feeling unwell
• Drainage from the area
• Swelling in the affected area
• Stiffness or inability to use an affected limb
PATHOPHYSIOLOGY
By: Anayatin & Yap
PATHOPHYSIOLOGY OF OSTEOMYELITIS
DIAGNOSTIC
TEST
By: BIAZON, SAMIRA & GUIALUDIN, HAIRAN
Radiographs Magnetic Resonance
(X-rays) Imaging (MRI)

Blood Tests
 Needle
aspiration

Biopsy Bone Scan

 Nursing
Management
By: PILANDOK & Bueno
 .
 Assess the patients vital
signs at least every 4
hours.
 Adjust the room
temperature and
promote bed rest.
 Administer the
prescribed medications.
 Offer a tepid sponge
bath.
• Elevate the head of the bead
• Apply cold and hot pack on the affected area.
• Monitor and perform wound dressing
• Provide a well balanced diet to promote healing
• Provide skin care thoroughly
• Watch for signs of pressure ulcer formation
• Encourage the patient to perform self care
• Encourage the patient to verbalize concerns
• Encourage the patient to perform activities that
promote rest and relaxation Such as deep breathing
exercise and provision of destructions like TV.
• Explain all the test and treatments procedures.
• Position in proper body alignment to prevent unusual
position or muscle stretching from increasing pain.
 Medical
management /
Treatment
By: Caspillo & Casanova
6
Medical
Management
By: Casanova
 Medical Therapy

Antibiotic treatment based on the identified pathogens from bone

cultures at the time of bone biopsy or debridement (Newman et al.
1991; Calhaun, 2005 as cited in Kishner, 2020).

Parenteral and oral antibiotics may be used alone or in combination,

depending on microorganism sensitivity results, patient compliance,
and infectious disease consultation (Kishner, 2020).
Prophylactic Treatment with
bed pouch technique

It is being suggested in open fractures to reduce risks of infection.

Systemic antibiotic in combination with antibiotic beads are
preferred than systemic antibiotics alone (Kishner, 2020).

But this method has been controversial in Europe; factors such as the
length of implantation, and the need of removal presents a risks for
secondary infection and development of resistant organisms
(Kishner, 2020).
 Antibiotic Therapy

Traditionally, antibiotic treatment of osteomyelitis consists of a 4 to

6-week course (Calhaun & Manring 2005 as cited in Kishner, 2020).

However, if all infected bones have been removed, antibiotic therapy

can be shortened to 10 days (Martinez, Sanchez, & Morales, 2014).
 Oral Antibiotics

Oral antibiotics may also be prescribed as it have been proven to be

effective, examples include: clindamycin, rifampin, trimethoprim-
sulfamethoxazole, and fluoroquinolones.
Suppressive antibiotic
therapy

It should be directed by bone culture and is given orally when

surgery is contraindicated (Calhoun, & Manring, 2005). It has a
good bioavailability, low toxicity, and adequate bone penetration
which are important for treatment.
Suppressive antibiotic
therapy

It should be directed by bone culture and is given orally when

surgery is contraindicated. It has a good bioavailability, low toxicity,
and adequate bone penetration which are important for treatment
(Calhoun, & Manring, 2005).
Amputate Drain
Drain the
the
Amputate the
the
limb infected
infected
limb..
area.
area.

Restore
Restore blood
blood flow
flow
surgical treatment to
to the
the bone.
bone.

Remove
Remove
diseased
diseased bone
bone Remove
Remove any
any
and tissue. foreign
and tissue. foreign objects.
objects.
Drugs
By: Guimadin & Sumlay
 Drugs

 Ceftriaxone 2 grams IV OD

 Omeprazole 40 mg IV OD

 Ketorolac 30 g IV q8

 Paracetamol 600mg IV q4
 Nursing Dx
(actual & potential)
By: Nanding & Adam
 Nursing Dx
Actual Nursing Diagnosis

Impaired Physical Mobility related to pain and limitation of the load

weight

Potential Nursing Diagnosis

Risk for Infection

Complications
By: Sampulna (A7) & Manaois (A5)
 Complications

• Bone death (osteonecrosis)

• Septic arthritis
• Impaired growth
• Skin cancer
 Complications

• Bone abscess

• Septicemia

• Recurrence of bone infection

Prevention
By: Silongan & Katab
 Prevention

Prevent
Avoid injury
Infection

Treat injured
site properly
PROGNOSIS
By: Sumail(A7) & Lauban(A5)
 PROGNOSIS
• The prognosis in patients with osteoarthritis depends on the joints involved and on
the severity of the condition. No proven disease-modifying or structure-modifying
drugs for osteoarthritis are currently known; consequently, pharmacologic
treatment is directed at symptom relief.
• Acute osteomyelitis is a surgical and medical emergency necessitating immediate
antibiotic therapy, surgical drainage, and secondary procedures as needed. The
prognosis of osteomyelitis depends on etiology, patient factors, and time to
institution of suitable treatment, as well as a host of other factors (eg, location,
organism, and antibiotic susceptibility and sensitivity).
• Chronic osteomyelitis is prolonged in its course and can be extremely debilitating,
with episodes of recurring infection interspersed with quiescent periods. The
organisms become increasingly resistant, and local treatment carries more value
than systemic therapy in the absence of acute exacerbation.
 References

• https://emedicine.medscape.com/article/1348767-treatmen
t#d9

• Calhoun JH, Manring MM. Adult osteomyelitis. Infect Dis

Clin North Am. 2005 Dec. 19(4):765-86.

• Lázaro-Martínez JL, Aragón-Sánchez J, García-Morales E.

Antibiotics versus conservative surgery for treating
diabetic foot osteomyelitis: a randomized comparative
trial. Diabetes Care. 2014. 37 (3):789-95.
 References

• https://www.mayoclinic.org/diseases-conditions/osteomye
litis/symptoms-causes/syc-20375913