August 20, 2010

 1% of pediatric admissions  Neonates*  Hematogenous spread*  Tibia or femur  50% associated with septic joint*  GBS & E.Coli  Older children*  Staph aureus*, Group A Strep, HIB, Salmonella (SCD)  Rare joint involvement

 Direct invasion  Spread from focus  Trauma  Staph aureus  Puncture  Pseudomonas  Sole of sneaker  E. coli  Animal Bite  Anaerobes  Staph

 Hematogenous*  Acute pain and decreased movement*  Possible swelling or redness*  Systemic Symptoms  Fever  Malaise  Irritability

 Following trauma  Insidious, subacute onset  Localized pain, edema and redness  Absence of systemic symptoms  Chronic  Local findings may be absent or intermittent  Possible sinus tracts  Absence of systemic symptoms

 Lab findings  Elevated or normal leukocyte  ESR/CRP elevated  Positive blood culture  50%

 Imaging  Plain films  1-2 weeks*  Edema of surrounding tissues  Periosteal reaction  New bone formation  2 weeks  Lytic lesions

 Imaging*  Bone Scan  2-3 days  Unclear location  Nonspecific  MRI  Specific  Abscess

 Stats  Older children  Mean 8.1y  Boys > Girls  Ilium > ischium or pubis  Right > left  Increased risk for abscess formation  Late diagnosis  Staph aureus

 Treatment*  High dose  Bactericidal levels in bone  4-6 weeks  Staph or Strep  Oxacillin or naficillin  1 st or 2 nd generation cephalosporins  Clindamycin  HIB  2 nd or 3 rd generation cephalosporin

 Treatment  Sickle Cell  3 rd generation cephalosporin  Other bugs to consider  Pseudomonas, anaerobes, GBS and E. coli

 Complications  Recurrence  5-10% are chronic  Abscess