Gå direkt till huvudinnehållet

Osteomyelit/Osteit

Senast reviderad:


Definition:
Infektion i ben (skelettet) orsakad av pyogen organism. 
Förekomst:
10/100 000 barn/år i Europa. Predisponerande faktorer: låg och hög ålder, kirurgi som involverar ben, diabetes mellitus och immunsuppression.
Symtom:
Feber, frysningar, påverkat allmäntillstånd och bensmärtor, lokala inflammationssymtom. Barnet vägrar att röra den påverkade extremiteten. Bland vuxna mindre uppenbara symtom och ofta subakuta och kroniska former, vanligen efter ett öppet sår.
Kliniska fynd:
Lokal ömhet och eventuellt andra inflammationstecken. Ofta nedsatt rörlighet i angränsande led.
Diagnostik: 
CRP, SR och LPK är ofta förhöjda, men inte alltid hos små barn. Mikrobiologi och bilddiagnostik.
Behandling:
Parenteral antibiotikabehandling på sjukhus.
  1. Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004; 364: 369-79. PubMed  
  2. Hatzenbuehler J, Pulling TJ. Diagnosis and management of osteomyelitis. Am Fam Physician 2011; 84: 1027-33. American Family Physician  
  3. Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum 2009; 39: 10-7. PubMed  
  4. Cierny G III, Mader JT, Penninck JJ. A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res 2003; (414): 7-24.
  5. Aragón-Sánchez J, Lázaro-Martínez JL, Quintana-Marrero1 Y, et al. Are diabetic foot ulcers complicated by MRSA osteomyelitis associated with worse prognosis? Outcomes of a surgical series. Diabet Med 2009; 26: 552-5. PubMed  
  6. Veileder i akutt pediatri, nettversjon, jan 2011
  7. Carek PJ, Dickerson LM, Sack JL. Diagnosis and management of osteomyelitis. Am Fam Physician 2001; 63: 2413-.
  8. Gutierrez K. Bone and joint infections in children. Pediatr Clin North Am 2005; 52: 779-94. PubMed  
  9. Saavedra-Lozano J, Mejias A, Ahmad N, et al. Changing trends in acute osteomyelitis in children: impact of methicillin-resistant Staphylococcus aureus infections. J Pediatr Orthop 2008; 28: 569-75. PubMed  
  10. Pollak AN, Jones AL, Castillo RC, Bosse MJ, MacKenzie EJ; LEAP Study Group. The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma. J Bone Joint Surg Am 2010; 92: 7-15. PubMed  
  11. Caputo GM, Cavanagh PR, Ulbrecht JS, Gibbons GW, Karchmer AW. Assessment and management of foot disease in patients with diabetes. N Engl J Med 1994; 331: 854-60. New England Journal of Medicine  
  12. Darouiche RO, Landon GC, Klima M, Musher DM, Markowski J. Osteomyelitis associated with pressure sores. Arch Intern Med 1994; 154: 753-58. PubMed  
  13. Zimmerli W. Clinical practice. Vertebral osteomyelitis. N Engl J Med 2010; 362: 1022-9. New England Journal of Medicine  
  14. Unkila-Kallio L, Kallio MJ, Eskola J, Peltola H. Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children. Pediatrics 1994; 93: 59-62. Pediatrics  
  15. Lipsky BA, Berendt AR, Deery HG, et al.; Infectious Diseases Society of America. Diagnosis and treatment of diabetic foot infections. Plast Reconstr Surg 2006; 117(7 suppl): 212S-238S.
  16. Chen WL, Chang WN, Chen YS, et al. Acute community-acquired osteoarticular infections in children: high incidence of concomitant bone and joint involvement. J Microbiol Immunol Infect 2010; 43: 332-8. PubMed  
  17. Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg 2009; 23: 80-9. PubMed  
  18. Santiago Restrepo C, Gimenez CR, McCarthy K. Imaging of osteomyelitis and musculoskeletal soft tissue infections: current concepts. Rheum Dis Clin North Am 2003; 29: 89-109. PubMed  
  19. Kaiser S, Rosenborg M. Early detection of subperiosteal abscesses by ultrasonography: a means for further successful treatment in pediatric osteomyelitis. Pediatr Radiol 1994; 24: 336-39. PubMed  
  20. Mah ET, LeQuesne GW, Gent RJ, Paterson DC. Ultrasonic features of acute osteomyelitis in children. J Bone Joint Surg Br 1994; 76: 969-74. PubMed  
  21. Kapoor A, Page S, Lavalley M, Gale DR, Felson DT. Magnetic resonance imaging for diagnosing foot osteomyelitis: a meta-analysis. Arch Intern Med 2007; 167: 125-32. PubMed  
  22. Termaat MF, Raijmakers PG, Scholten HJ, Bakker FC, Patka P, Haarman HJ. The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis. J Bone Joint Surg Am 2005; 87: 2464-71. PubMed  
  23. Dirschel DR. Acute pyogenic osteomyelitis in children. Orthop Rev 1994; 23: 305-12. PubMed  
  24. Bressler EL, Conway JJ, Weiss SC. Neonatal osteomuyelitis examined by bone scintigraphy. Radiology 1984; 152: 685-8. PubMed  
  25. Termaat MF, Raijmakers PG, Scholten HJ, Bakker FC, Patka P, Haarman HJ. The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis. J Bone Joint Surg Am 2005; 87: 2464-71. PubMed  
  26. Peltola H, Unkila-Kallio L, Kallio MJT. Simplified treatment of acute staphylococcal osteomyelitis of childhood. Pediatr 1997; 99: 846-50. PubMed  
  27. Roblot F, Besnier JM, Juhel L, et al. Optimal duration of antibiotic therapy in vertebral osteomyelitis. Semin Arthritis Rheum 2007; 36: 269-77. PubMed  
  28. Eckardt JJ, Wirganowicz PZ, Mar T. An aggressive surgical approach to the management of chronic osteomyelitis. Clin Orthop 1994; 298: 229-39. PubMed  
  29. Boxma H, Broekhuizen T, Patka P, Oosting H. Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial. Lancet 1996; 347: 1133-37. PubMed  
  30. Brook I, Frazier EH. Aerobic and anaerobic microbiology of infection after trauma. Am J Emerg Med 1998; 16: 585-91. American Journal of Emergency Medicine  
  31. Norden C, Nelson JD, Mader JT, Calandra GB. Evaluation of new anti-infective drugs for the treatment of infections of prosthetic hip joints. Clin Infect Dis 1992; 15 :(suppl 1) S177-81.
  32. Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 2008; 23: 984-91. PubMed  
  • Bertil Christensson, professor och överläkare, Infektionskliniken, Skånes universitetssjukhus