Diagnosis-osteomyelitis

(JAMA 2008;299:806)

參考➡️ Does this patient with diabetes have osteomyelitis of the lower extremity?

• Crucial to obtain cx data of causative organism to avoid long-term empiric abx
• Bone biopsy or tissue cx obtained surgically or via percutaneous biopsy (send aerobic, anaerobic, mycobacterial, and fungal cultures + pathology) unless ⊕ blood cx. Do not rely on swabs of ulcers or fistulae drainage.
• Physical exam: high suspicion in diabetic foot (see above) if can probe ulcer to bone or ulcer >2 cm2 (Sp 83%, 90% PPV)
• Blood cultures before antibiotics (more often ⊕ w/ acute hematogenous osteomyelitis)
• CBC, CRP, ESR (>70 greatly ↑ likelihood of osteo)

• Imaging-Diagnosis-osteomyelitis

Explain by ChatGPT

A diagnosis of osteomyelitis is important to obtain data of the causative organism to avoid long-term empiric antibiotics. A bone biopsy or tissue culture obtained surgically or via percutaneous biopsy is the best way to obtain this data (send aerobic, anaerobic, mycobacterial, and fungal cultures + pathology), unless the blood culture is positive. Do not rely on swabs of ulcers or fistulae drainage.

The physical exam is important in patients with a high suspicion of osteomyelitis, such as in diabetic foot (see above) if the ulcer can be probed to bone or if the ulcer is expanding. Blood cultures should be obtained before antibiotics are given (more often positive with acute hematogenous osteomyelitis). A CBC, CRP, and ESR should also be ordered.

窩的英文不太好

骨髓炎的診斷對於獲取致病微生物的數據以避免長期經驗性抗生素很重要。除非血培養呈陽性，否則通過手術或經皮活檢獲得的骨活檢或組織培養是獲得此數據的最佳方式（送需氧、厭氧、分枝桿菌和真菌培養 + 病理學）。不要依賴於潰瘍或瘻管引流的拭子。

身體檢查對於高度懷疑骨髓炎的患者很重要，例如糖尿病足（見上文），如果潰瘍可以探查到骨骼或潰瘍正在擴大。應在給予抗生素前進行血培養（急性血源性骨髓炎更常呈陽性）。還應訂購 CBC、CRP 和 ESR。