Antibiotics for bone osteomyelitis

How to identify the disease

At the outset, it is almost impossible to determine the presence of osteomyelitis, because there are simply no symptoms. As a rule, everything begins with an increase in body temperature, which in a short period rises to 40 degrees. There is an increase in heart rate, poor health, weakness and lethargy. At the same time mistakenly a false diagnosis is made, for example - the flu.

After a few days from the moment of infection, the first real signs begin to appear. This is pain over the place where bone damage, edema and redness of the skin develop. Most often, the leg bones are involved in the process. But the bones of the hands are relatively rare. Such signs are characteristic for an infection that is carried along the bloodstream. And if a person first observes these signs, then we can talk about the presence of acute hematogenous osteomyelitis.

If the inflammation of the bone is exogenous, then here is the presence of a wound in the foreground. The following signs are revealed: redness of the skin at the wound site, edema, general malaise, pain, edema. If the disease runs for a long time and there are periods of exacerbation and remission in it, then we can talk about the chronic process.

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Correct therapy

To treat the inflammatory process of the bone is possible only in the hospital. Houses to cope with such a serious disease will not work. At the forefront here is a serious antibiotic therapy. Simultaneously, 2 or even 3 drugs are prescribed at once. Treatment with them can last up to 2 - 3 months. Simultaneously, detoxification therapy and purification of blood from a huge number of microbes

are mandatory. When treating antibiotics, it is necessary to use preparations of probiotics and prebiotics, as dysbiosis often starts to develop, and this greatly reduces immunity. In order to improve circulation in the affected area, it is necessary to use such medications as trental or pentoxifylline.

Of particular importance is wound dressing. This should be done daily, using a variety of antibacterial ointments, for example - levomecol or levosin. To cleanse the wound from purulent contents, it is desirable to use trypsin or chymotrypsin in dressings.

If necessary, have to use and surgery. During the operation, the wound is cleaned, the bone tissue removed, which has already become unviable, performing recovery operations, for example, the installation of Ilizarov's apparatus.

Complications of

Acute osteomyelitis is a very serious disease that has a lot of complications:

  1. Phlegmon.
  2. Purulent inflammation of the joint, which is directly above the bone destruction site.
  3. Spontaneous fracture.

Osteomyelitis - Causes, symptoms and treatment. MF

• low body weight, poor nutrition.

Symptoms of osteomyelitis

Diagnosis of acute hematogenous osteomyelitis in early stages is difficult.

Common and local symptoms of the disease can be identified. The general picture of the disease, caused by the presence of bacteria in the blood( bacteremia), is as follows: after a short period of malaise, chills appear, the temperature rises from 37.5 ° C to 40 ° C, and the pulse rate increases( above 90 beats per minute).At this stage, osteomyelitis can be considered a normal acute respiratory infection( eg, influenza).

On the 2nd - 3rd day of the disease, local symptoms appear in the form of local pain over the affected area, restriction of mobility and edema of the soft tissues of the extremity segment, redness of the skin. The bones of the lower extremities are most often affected( femoral and tibial).Of the bones of the upper limb, the shoulder, then the ray and the ulnar are more often affected. Less often, the bones of the hand and foot are involved in the process, as well as the ribs, spine, collarbone, pelvis, and scapula.

In the case of exogenous acute osteomyelitis, local signs of the disease come to the fore: the presence of a purulent wound, the trauma and deformity of the limbs, the reddening and rising skin temperature, the swelling and tenderness of the soft tissues to the touch, pain while moving in the affected area of ​​the body. Common symptoms are less pronounced and usually go to the background.

With such symptoms for osteomyelitis, you can take an abscess( a limited accumulation of pus in the soft tissues), phlegmon( a common purulent infection in soft tissues), erysipelas, posttraumatic hematoma( local blood accumulation).These conditions also require urgent medical attention.

In the chronic course of the disease, the previously transferred osteomyelitis and the presence of fistulous passages are added to the above symptoms( round purulent wounds of small diameter on the skin from which the purulent discharge comes).

First aid for suspected osteomyelitis

Post-traumatic osteomyelitis develops after a time( 1 to 2 weeks) after getting injured, so it is important to properly treat the wound and contact the doctor in a timely manner. If you have received extensive trauma with a violation of the integrity of the skin, then the wound should be rinsed with a soap solution and 0.05% chlorhexidine bigluconate solution in order to mechanically remove microorganisms. The skin around the wound should be treated with a solution of brilliant green, put a sterile napkin on the wound( sold at the pharmacy).The napkin can be impregnated with a 3% hydrogen peroxide solution to stop bleeding. The limb should be immobilized. You can attach ice. Then you need to go to the emergency room, where you will be examined by a trauma doctor.

Treatment of osteomyelitis, which arose after fractures, as well as operations of metalloesteosynthesis, are performed by trauma doctors. In other cases( hematogenous osteomyelitis, contact osteomyelitis), you should seek the help of a surgeon in the on-duty surgical hospital or a surgeon in a polyclinic.

Often in the case of hematogenous osteomyelitis, patients enter non-core units, in particular, into the infectious or therapeutic department. However, after the manifestation of the symptoms of damage to the bone, they are transferred to the surgical department.

Hospital examination for suspected osteomyelitis

For the diagnosis of osteomyelitis, the following examination will be necessary. To pass the general analysis of a blood and urine, the analysis of a blood on level of a glucose( for that to reveal a diabetes).If possible, you need to donate blood to C-reactive protein, which is a sensitive indicator of inflammation.

In the presence of an open purulent wound or fistulous course, a purulent discharge is sown from them in order to determine the causative agent and its sensitivity to antibiotics.

For visual confirmation of the presence of osteomyelitis, radiograph the affected area of ​​the body. However, it should be remembered that the x-ray picture of the disease is 2 weeks behind the clinical one, therefore, in case of acute osteomyelitis, there can be no obvious changes in the onset of the disease.

The figure shows a typical radiographic picture of osteomyelitis - a cavity in the bone, a pathological fracture. A more sensitive diagnostic method is computed tomography, which allows for more detailed examination of bone tissue defects. The possibilities of computed tomography exceed magnetic resonance imaging. The latter allows to differentiate soft tissue diseases from the affected bone, determine the length of nonviable tissues. Therefore, when choosing between computer and magnetic resonance imaging, the latter should be preferred.

It is possible to perform an ultrasound. It allows to identify the accumulation of pus in soft tissues, the presence and extent of fistulous passages, changes in the periosteum, and also assess the blood supply to the limb.

The most modern way to diagnose osteomyelitis is radionuclide diagnostics. The method is based on the use of radioactive pharmaceuticals, which specifically accumulate in the inflammatory focus, which allows early detection of the presence of bone tissue destruction. Unfortunately, this is an expensive study that requires high-tech equipment and a special room, so it is only available in large medical centers.

Treatment of osteomyelitis

Treatment of osteomyelitis is complex, it is possible only in hospital settings in traumatological or surgical departments, it includes conservative and surgical measures.

Conservative treatment methods include:

• antibacterial therapy with broad-spectrum antibiotics - usually 2 -3 drugs( ceftriaxone, lincomycin, gentamicin) are prescribed for a long time( 3 to 4 weeks), replacing them with drugs from other groups( eg, ciprofloxacin, abaktal, etc.)) • detoxification therapy( intravenous saline solutions and plasmapheresis, procedures for ultraviolet and laser irradiation of blood - purification of blood plasma from toxins) • immunotropic therapy - use of pharmaceuticals that increaseactivity of the immune system( polyoxidonium) • administration of probiotics - drugs that normalize the intestinal microflora. Due to massive antibacterial therapy, dysbacteriosis develops. For its correction, appoint a linex, bifiform, • prescribe drugs that improve blood microcirculation( pentoxifylline, trental), • local wound treatment, dressings with antiseptic ointments( levomecol, levosin, 5% dioxidin ointment) and proteolytic enzymes( trypsin, chymotrypsin) that promotepurification and healing of the wound.

Surgical treatment of osteomyelitis consists in the sanation of a purulent focus( opening and draining of purulent cavities), removal of sequesters - areas of non-viable bone tissue and performing recovery operations. Implementation of the latter is necessary due to the formation of defects in the skin and bone tissue. Restorative operations include closure of defects by local tissues, bone filling with various preparations and osteosynthesis( for example, Ilizarov apparatus).

Osteosynthesis with Ilizarov's apparatus

There are no restrictions on the diet after the operation. A full-fledged diet rich in vitamins and proteins is needed. The amount of physical activity should be discussed with the attending physician individually. It is advisable to refrain from drinking alcohol, smoking - they slow down the healing process of the wound. In the presence of diabetes, blood sugar levels should be monitored, if it increases, a relapse of the disease is possible. In the postoperative period and after discharge from the hospital, therapeutic physical therapy and physiotherapy( electrophoresis, phonophoresis, magnetotherapy) are necessary.

Possible complications of osteomyelitis

Osteomyelitis complications can be local and general.

Local complications include:

• abscess and phlegmon of soft tissues - accumulation of pus and purulent impregnation surrounding the affected bone of soft tissues • purulent arthritis - purulent inflammation of the joint located next to the osteomyelitis focus • spontaneous fractures - occur at the slightest strain due toloss of bone tissue strength • contractures - impaired mobility due to the formation of scars in the muscles surrounding the purulent focus • ankylosis - loss of mobility in the joints affected by purulent arthritis;

General complications include:

• sepsis - blood infection • secondary anemia - anemia, develops due to oppression of hematopoiesis against a background of chronic inflammation • amyloidosis - an autoimmune disease that primarily affects the kidneys, is difficult to treat.

Prevention of complications of osteomyelitis

The incidence of complications and the likelihood of the transition of osteomyelitis to the chronic stage directly depends on the time of going to the doctor. That is why it is so important to contact a specialist at the first signs of the disease. Do not self-medicate: in the presence of a purulent focus in the bone or soft tissues, it is necessary to give an outflow of pus( perform the operation).Until this is done, even the use of modern antibiotics will be ineffective.

As Arthur Schopenhauer said: "Health before that outweighs all other benefits of life, that a truly healthy beggar is happier than a sick king."Therefore, take care of your health. It is better to overestimate the severity of your symptoms than it is too late to seek medical help.

Surgeon-physician Tevs DS

Symptoms and treatment of osteomyelitis on

Osteomyelitis is a condition in which all parts of the bone are affected. This disease is characterized by the course of the purulent-necrotic process , which develops in the bone of the , and also in the bone marrow of the .Inflammation can develop in the soft tissues surrounding the bone. This process causes pyogenic bacteria and or mycobacteria ( that is, those that produce pus).

The disease was first discovered in the mummies of Ancient Egypt, it was also described by the famous Greek physician Hippocrates. To date, osteomyelitis is relatively rare, but its treatment to the present day is a difficult process.

Types of osteomyelitis

As of today, it is common to distinguish between hematogenic osteomyelitis , which is manifested by the ingress of microbes into the bone through the circulation, and non-hematogenous osteomyelitis ( posttraumatic osteomyelitis) as a secondary disease, manifested as a complication of wounds, that is, in a non-hematogenous way, whenin the bone microorganisms from the external environment. At the initial stage of development, both types of inflammation of the bones have a different origin. But at the later stages, these diseases become similar, which is why they have a common name. According to the peculiarities of the clinical course, it is customary to distinguish acute and chronic osteomyelitis .In most cases, chronic osteomyelitis is a consequence of the acute form of the disease. However, in some cases, chronic osteomyelitis is the primary form of the disease.

Hematogenous osteomyelitis

Hematogenous osteomyelitis is most common in patients in childhood, as well as in adolescent boys. As a rule, the localization of the process takes place in the of the femur and of the tibia bones .More rarely, the disease manifests itself in the remaining bones. Inflammation occurs due to the entry of microbes into the bone marrow through the circulation. The primary focus of microbes can become carbuncles , boils , cellulitis , panaritiums , abscesses , mug , caries , infected abrasions and other diseases. The development of the disease affects a number of factors: anatomical and physiological , biological and immunobiological , predisposing .

These are the characteristic features of the supply of blood to the bones of the child( in children in the area of ​​bone growth there is a whole loopy network of small vessels, so they often settle a variety of microorganisms).The disease often develops if the body reacts in a peculiar way, a reaction that is similar to an allergic reaction. Immediate factors contributing to the development of the disease can be trauma to the bone, reduced resistance to the body, which contribute to the disease, overstrain , lack of vitamins.

Non-hematogenous osteomyelitis

In this form of disease, microorganism pathogens enter bone from the environment during injuries from firearms, with severe soft tissue damage, during open fractures. Due to the development of the local process, blood supply to the bone is impaired and, as a consequence, its necrosis of , i.e., death, occurs. Non-hematogenous osteomyelitis differs from the hematogenous form of the disease in that the inflammation can begin in the bone marrow and in the periosteum.

Symptoms of acute hematogenous osteomyelitis

The initial symptoms of this disease, which manifest themselves in the very first days, is general weakness and malaise, a feeling of aching in the limbs, muscle pain, headache .A little later the patient feels a strong chill, while the body temperature rises to 39 degrees. To the initial symptoms may be associated with vomiting, a sense of weakness. The patient feels very ill, obscurations of consciousness appear, delirium, the meninges are irritated, sometimes convulsions appear. The patient does not have an appetite, the dryness of the tongue is noted. In addition, the symptoms of acute hematogenous osteomyelitis is the pallor of the face, dry skin, which, in addition, acquires a yellowish hue, cyanotic, mucous membranes. The arterial pressure of is reduced in the patient, the deaf heart sounds are listened, the pulse is quickened, the breathing becomes frequent and superficial. During palpation, the doctor often finds an enlarged liver and spleen. The kidney area is sometimes painful.

One or two days after the onset of the disease, painful sensations begin to appear that have strict localization in the affected limb. In this case the pain has a vomiting character, in view of which children often after the smallest limb movements strongly scream from increased pain. In some cases, because of severe pain, the child is forced to keep the limb in a state of complete immobility. This state is called pseudo-parsing .Also in the first days, swelling of the soft tissues begins, which is accompanied by a distinct morbidity. The skin in the lesions is red and swollen, its temperature rises. The swelling of the diseased limb is constantly increasing, after a while the enlarged veins become visible, the regional lymph nodes are enlarged. Often with this condition develops sepsis.

Depending on how severe the disease is, distinguish local focal , toxic ( fulminant ) and septicopyric form of acute type of disease. The localized osteomyelitis is characterized by the most stable course. The disease begins in a completely healthy child who complains of pain in a particular place. The temperature rises to 39-40 degrees C, over time, there is a restriction of movement, Gradually appear: restriction of joint movements, redness of the skin, severe persistent pain.

In septicopyemic form, the patient has many purulent foci in a short time, and this process occurs in parallel in the internal organs or bones.

In case of toxic form, a person can sharply lose consciousness, rave. These signs are called signs of "septic intoxication".They are unusually fast progressing and lead to death in the first hours or days of the disease. In this case, clinical signs from the side of bones and soft tissues do not have time to form.

In adults, as a rule, hip or spine is affected by hematogenous osteomyelitis. Accordingly, in this area there are pains. However, due to the many reasons for the occurrence of pain in these areas, the diagnosis of osteomyelitis in adults is sometimes more difficult than in children.

The course of acute hematogenous osteomyelitis directly depends on how timely the treatment of the disease began, which primarily involves taking antibiotics.

As a rule, acute osteomyelitis becomes chronic because of the continuing necrosis of the infected area of ​​the spongy or compact layer of bone. In patients who suffer from chronic osteomyelitis, clinical symptoms tend to be negligible. Their amplification is observed only in case of exacerbation of inflammation. Clinical manifestations of symptoms are aggravated if the overall resistance of the body is reduced due to the presence of infection in the bone. A similar phenomenon can provoke cooling, trauma, serious illnesses and other phenomena.

Diagnosis of osteomyelitis

In the process of diagnosis of acute hematogenous osteomyelitis, methodical palpation is carried out with care, with the help of which it is possible to determine the most painful area, which will correspond to the center of development of the inflammatory process.

With the help of X-ray examination, it is possible to determine the localization and extent of the lesion, and also to establish how severe the changes were from the pathoanatomical point of view. However, with the help of X-ray study, the symptoms of the disease can be detected only from the 10-14 day of the disease development. In an X-ray examination, isolated fracture sites can be determined. When examining the roentgenogram, they are seen as holes in the bone. In some cases, the use of the method of computed tomography is expedient for establishing an accurate diagnosis. If the expert suspects that the patient has chronic osteomyelitis, sometimes the fistulography method is used for diagnosis. This method of diagnostics makes it possible to identify the location of sequestration in the event that conventional images do not show the necessary data clearly enough. In the process of applying this method, contrast substances( sergozin, iodolipol, diodon) are used. The most accurate results can be obtained due to the application of the method of radioactive scanning, for which radioactive technetium is used.

Also in the process of diagnosing osteomyelitis a complex of laboratory tests is used. So, the most informative method is the determination of erythrocyte sedimentation rate( ESR ), which indicates the presence of an inflammatory process in the body.

In order to finally clarify the diagnosis, biopsy is often used with the sampling of tissues. Puncture of the bone is performed under with anesthesia .This technique is also used for bacteriological research.

Treatment of osteomyelitis

To date, antibiotics are widely used in the treatment of osteomyelitis. This method of therapy significantly improved the effectiveness of conservative treatment and, accordingly, reduced the need for operations. Modern therapy of hematogenous osteomyelitis includes a number of measures of general action on the patient's body, as well as the use of local effects on the focus of infection.

In the first days after the development of the disease, immobilization is carried out, which limits the process, reduces pain.

In more rare cases, an operation is required that is used if the disease is too triggered and a phlegmon developed. The operation is also conducted to remove sequestrants.

To date, the most effective method is the method of gentle osteoperforation. If the patient has a subperiosteal phlegmon, its dissection is performed without detachment of the periosteum. After this, the milling holes are applied directly to the bone. Through the holes in the bone, the bone marrow canal is drained, and antibiotics and antiseptic agents are injected into the bone.

As general methods of conservative treatment, antibiotic therapy, detoxification, physiotherapy, correction of immunity disorders are used.

Section: Infectious DiseasesOrthopedics and Traumatology Author: Marina Stepanyuk - pharmacist, medical journalist Specialization: Pharmaceuticals more

Education: Graduated from the Rivne State Basic Medical College with a degree in Pharmacy. Graduated from Vinnytsia State Medical University. MI Pirogov and internship on its base.

Work experience: From 2003 to 2013 - worked as a pharmacist and head of the pharmacy kiosk. She was awarded with diplomas and marks of distinction for her long and diligent work. Articles on medical topics were published in local publications( newspapers) and on various Internet portals.

Osteomyelitis - Orthopedics

Currently, the name "osteomyelitis" combines inflammation of all parts of the bone: bone itself( osteitis), bone marrow( myelitis) and periosteum( periostitis).

Reasons for

Osteomyelitis is caused most often by the following bacteria: streptococcus, staphylococcus, salmonella and E. coli. Less often, inflammation of the bone can occur as a complication of tuberculosis, syphilis, leprosy and some other diseases. In order to get into the bone, bacteria exists only two ways: the inner and the outer. In the first case, the infection is carried along with the blood flow from a distant pathogenic focus( hematogenous osteomyelitis).This can occur with caries, sinusitis, angina, intestinal fistula, and the like. In the second - the trigger mechanism is injury. Infection penetrates into the bone with open fractures, gunshot wounds, deep injuries and non-sterile surgical operations( traumatic osteomyelitis).

How is this manifested?

Hematogenous osteomyelitis is more dangerous than traumatic. Most often it is preceded by a short period( 1-4 days), during which the disease almost does not manifest itself. A person can complain about weakness, pain in muscles, aches in joints, while local manifestations are absent. Then the temperature rises sharply, the thermometer can rise to 39-40 degrees. Pain, clearly localized in the affected area of ​​the bone, appears almost immediately. Sharp, boring or bursting from within, intensifying with the slightest movement - such pain is difficult with anything to mix up.

Further development of the disease occurs very quickly. The general condition worsens, the purulent process spreads to the surrounding muscles and skin, sepsis develops often. If you do not take emergency measures, a fatal outcome is possible.

In case of traumatic osteomyelitis, the disease can pass into a chronic form, in which the pus and tissue decay products go out through the fistulas. In severe cases, the outcome of the disease is the same as with hematogenous osteomyelitis.

Diagnosis of

to a trauma doctor, and if you can not go yourself - call an ambulance. It is important to recognize the disease as soon as possible. To do this, you need a general blood test and a general urine test, according to which the doctor finds out how far the inflammatory process has gone. To assess the condition of the affected area, perform an X-ray. However, it must be taken into account that at the initial stage of the disease this method of investigation is not always informative. But with the help of radioisotope scanning, a reliable result can be obtained two days after infection. Sometimes the doctor appoints a computer or magnetic resonance imaging of the bone to clarify the diagnosis.

Treatment of

Infection is destroyed with antibiotics, and the drug is selected individually, depending on the type of bacteria that have settled into the bone. Antibiotics will have to be taken within 4-6 weeks. The intake of antimicrobial drugs inside is often supplemented by local administration. Surgical treatment is widely used. In the course of the operation, the purulent focus is cleared, the dead soft tissues are removed, and if necessary, a resection( excision) of the damaged bone site is performed.

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