🦠 Chapter 725 · Osteomyelitis

Nelson Textbook of Pediatrics 22nd Edition | Acute hematogenous osteomyelitis — most common in children, metaphyseal location. S. aureus most common (including MRSA). Kingella kingae common in children 6 months-4 years (often subacute, requires PCR). MRI is gold standard (STIR sequence). CRP monitoring guides response. Treatment: IV antibiotics (cefazolin/nafcillin; clindamycin/vancomycin for MRSA), duration 3-4 weeks (convert to oral when improving). Surgical drainage for abscess or failed response. CRMO (chronic recurrent multifocal osteomyelitis) — sterile inflammation, autoinflammatory.

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📋 30 Clinical Scenarios — Osteomyelitis

📇 High‑Yield Review Cards

🩺 Clinical Recognition: Osteomyelitis

Select a presentation to review diagnostic clues and management per Nelson Ch 725.

📋 Stepwise Management of Osteomyelitis

🔑 Key Principles — Nelson Chapter 725
• Pathogens: S. aureus (MSSA > MRSA), Kingella kingae (6m-4y, PCR), Group A strep, Group B strep (neonates), Salmonella (sickle cell), Pseudomonas (puncture wound).
• Imaging: MRI with STIR is gold standard. Radiographs normal first 7-14 days.
• Labs: CRP most useful (elevated, monitors response). ESR elevated but slow to normalize.
• Treatment: IV antibiotics 3-4 weeks (convert to oral after clinical improvement, CRP trending down). Cefazolin for MSSA; clindamycin/vancomycin for MRSA.
• Surgery: Drainage for subperiosteal abscess, failed response, or need for diagnosis.

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: Osteomyelitis (Nelson 725)