Review Question - QID 1063

This patient's history, physical examination, and imaging is consistent with acute hematogenous osteomyelitis (AHO) following minor trauma to the ankle.

Song et al present Level 5 evidence stating that sequential parenteral-oral antibiotic regimens are the mainstay of AHO treatment. ESR and CRP are positive in AHO cases up to 91% and 97%, respectively. Failure of the CRP level to fall rapidly after initiation of antibiotic treatment has been predictive of long-term sequelae. Aspiration of bone to be sent for culture can identify the offending organism and offer organism-directed antibiotic therapy but can often have false negative culture results. Blood cultures (results pending in this case) are only positive 30-60% of the time and in many cases treatment of presumed infections is empirical, based on clinical and radiographic criteria. Empirical antibiotic coverage should always include coverage for Staphylococcus aureus, since it is the most common pathogen in all age groups. The presence of a soft-tissue or intra-osseous abcess, concomitant septic arthritis, failure to respond to antibiotic therapy are generally recognized indications for surgical intervention.