Infection of bone due to hematogenous seeding or direct spread from contiguous focus Microbiology (fcf/M 1997:33*999)

• Hematogenous: S. aureus; mycobacterial infection of vertebral body Pott's disease

• Contiguous focus (may be acute or chronic)

open fracture, orthopedic surgery, etc.: S. aureus and S. epi • vase, insuffic. (eg. diabetic foot): polymicrobial (aerobic 4 anaerobic GPC & GNR) Clinical manifestations

• Surrounding soft-tissue compromise • fistula to superficial skin

• Vertebral osteomyelitis (common manifestation in adults over 50 y): unremitting, focal back pain and usually fever

• t Fever, malaise, and night sweats (more common in hematogenous than contiguous) Diagnostic studies

• Identification of the causative organism is key

• Culture data from tissue (surgical sampling/needle bx) not swabs of ulcers/fistulae

• Blood cultures (more often © with acute hematogenous osteomyelitis)

• Imaging plain radiographs: normal early in disease: lytic lesions seen after 2-6 wks CT: can demonstrate periosteal reaction 3nd cortical and medullary destruction MRI: can detect very early changes

CT & MRI very Se but not completely Sp: false >) if contiguous focus w/ periosteal reaction. Charcot changes radionuclide imaging: very Se but non-Sp (false © if soft-tissue inflammation) Treatment

• Surgery should be considered for any of the following:

acute osteo that fails to respond to medical therapy chronic osteo complications of pyogenic vertebral osteo (eg. early signs of cord compression, spinal instability, epidural abscess) infected prosthesis

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