Abstract
Most cases of reported osteomyelitis in stage 4 pressure ulcers are almost exclusively chronic and superficial (when depth is reported). Wound cultures or bone specimen cultures lack diagnostic sensitivity or specificity. Histopathological diagnosis is necessary to make an accurate diagnosis of osteomyelitis. Surgical debridement is the mainstay of treatment for chronic osteomyelitis. Duration of antibiotics in combination with surgical management is unclear but choice should consider bone and biofilm penetration. Shorter durations of antibiotics to treat the soft tissue infection should be considered in the absence of a concrete plan for wound coverage with primary closure or rotational flap.
Highlights
Key PointsMost cases of reported osteomyelitis in stage 4 pressure ulcers are almost exclusively chronic and superficial (when depth is reported)
Osteomyelitis is, by definition, inflammation of the bone and the bone marrow that can be secondary to bacteria, mycobacteria, or fungi [1]
If there are no signs of sepsis, a cephalosporin with coverage for Staphylococcus aureus, Streptococcus, and enterobacteria would be reasonable
Summary
Most cases of reported osteomyelitis in stage 4 pressure ulcers are almost exclusively chronic and superficial (when depth is reported). Wound cultures or bone specimen cultures lack diagnostic sensitivity or specificity. Histopathological diagnosis is necessary to make an accurate diagnosis of osteomyelitis. Surgical debridement is the mainstay of treatment for chronic osteomyelitis. Duration of antibiotics in combination with surgical management is unclear but choice should consider bone and biofilm penetration. Shorter durations of antibiotics to treat the soft tissue infection should be considered in the absence of a concrete plan for wound coverage with primary closure or rotational flap
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