tailieunhanh - Chapter 120. Osteomyelitis (Part 7)

Contiguous-Focus Osteomyelitis Even when diagnosed early, contiguous-focus osteomyelitis usually requires surgery in addition to 4–6 weeks of appropriate antibiotic therapy because of underlying soft tissue infection or damage to bone from an injury or surgery. A 2-week course of antibiotics after thorough debridement and soft tissue coverage has yielded adequate results in the treatment of superficial osteomyelitis involving only the outer cortex of bone. Chronic Osteomyelitis The risks and benefits of aggressive therapy for chronic osteomyelitis should be weighed before any attempt is made to eradicate the infection. Some patients with extensive disease prefer to live with their infections rather than undergo multiple. | Chapter 120. Osteomyelitis Part 7 Contiguous-Focus Osteomyelitis Even when diagnosed early contiguous-focus osteomyelitis usually requires surgery in addition to 4-6 weeks of appropriate antibiotic therapy because of underlying soft tissue infection or damage to bone from an injury or surgery. A 2-week course of antibiotics after thorough debridement and soft tissue coverage has yielded adequate results in the treatment of superficial osteomyelitis involving only the outer cortex of bone. Chronic Osteomyelitis The risks and benefits of aggressive therapy for chronic osteomyelitis should be weighed before any attempt is made to eradicate the infection. Some patients with extensive disease prefer to live with their infections rather than undergo multiple surgical procedures take prolonged courses of antimicrobial therapy and face the risk of loss of an extremity. Such persons often benefit from intermittent courses of oral antibiotics to suppress acute exacerbations. Once the decision has been made to treat chronic osteomyelitis aggressively the patient s nutritional and metabolic status should be optimized to expedite healing of soft tissues and bone. Antibiotic administration should be started several days before surgery to reduce inflammation if the etiology of the infection is known if not antibiotic therapy should be withheld until debridement. A 4- to 6-week course of appropriate antibiotic therapy is given postoperatively on the basis of the susceptibility pattern of organisms isolated from bone. A subsequent prolonged course of oral antibiotic therapy is often prescribed especially in the setting of a foreign body but controlled data for this approach are lacking. There are insufficient data to recommend either the routine use of hyperbaric oxygen or the use of antibiotic-impregnated methacrylate beads or other depots to deliver high levels of antibiotics to the bone. The success of therapy for chronic osteomyelitis still rests largely on the complete .