Osteomyelitis, diabetic foot ulcers and the role of the community nurse.

Community nurses face numerous challenges in both diagnosing and effectively treating their patients. The diabetic patient has complex needs requiring a holistic approach. With a reported increase in diabetic patients, and a possible decline in some routine screening following Covid-19 pandemic, complications in diabetic patients are likely to rise. It is estimated that 25% of diabetic patients will develop a diabetic foot ulcer (DFU), with a reported 43% of DFU already infected at first presentation to a health professional. NICE categorise the level of infection in DFU based on standardised assessments such as SINBAD. A high categorised DFU has the possibility of osteomyelitis. It is imperative that osteomyelitis is treated immediately to achieve positive outcomes, benefitting the patients' health and wellbeing in addition to reducing the financial implications to the NHS.

[Treatment of pubic osteomyelitis secondary to pressure sores]. / Le traitement des ostéites du bassin secondaires aux escarres.

There is no consensus regarding the diagnostic and therapeutic strategy for pubic osteomyelitis secondary to pelvic pressure sores. Diagnosis is often difficult and bone biopsies with microbiological and anatomical-pathological examination remain the gold standard. The rate of cicatrisation of pressure sores is low. Cleansing and negative pressure treatment are key elements of the treatment. Optimising the care management with medical-surgical collaboration is being studied in the Ostear protocol.

Wound-related osteomyelitis: a case of containment not cure.

Community nurses need to be aware that some patients with osteomyelitis are treated with antibiotics alone. Such patients often have co-morbidities and quality of life issues that directly impact on the decision to treat osteomyelitis surgically. However, adopting a conservative approach to osteomyelitis management is associated with an increased risk of osteomyelitis recurrence. The rationale for managing chronic wound-related osteomyelitis with antibiotics is discussed. Community nurses caring for patients that have received antibiotics alone to treat osteomyelitis need to be aware of the potential for osteomyelitis recurrence and how to make the diagnosis.

A critical review of the literature: part II: antibiotic treatment of osteomyelitis in patients with diabetes and foot ulcers.

The diagnosis and treatment of osteomyelitis in the diabetic patient with a foot ulcer presents a difficult challenge for WOC nurses. Treatments vary greatly in terms of time, cost, and invasiveness, as does the accuracy of the underlying diagnosis. For example, the choice of oral versus parenteral antibiotics, the length of therapy, and decisions about surgical intervention or aggressive debridement are based on accurate differentiation of osteomyelitis from soft tissue infection, osteoarthropathy, or other related conditions. This article is the second of a critical literature review designed to identify the best evidence for diagnosing and treating osteomyelitis in patients with diabetes. It focuses on the existing evidence base for antibiotic therapy.

A critical review of the literature: part I: diagnosing osteomyelitis in patients with diabetes and foot ulcers.

Despite our best efforts, chronic wounds continue to confound us. Cases of patients with diabetes who have wounds are particularly perplexing and challenging to manage. The diagnosis and treatment of osteomyelitis in this population are of great interest to clinicians. Much of wound care is based on tradition and expert opinion. The current focus is on evidence-based practice. The purpose of this critical literature review is to determine the best evidence for diagnosing osteomyelitis as a basis for providing appropriate therapy to patients with diabetes and foot ulcers. Treatments vary greatly in terms of time, cost, and invasiveness depending on the accuracy of the diagnosis. The choice of oral versus parenteral antibiotics, the length of the treatment, and decisions about surgical intervention or aggressive debridement are based on correctly differentiating osteomyelitis from soft tissue infection, osteoarthropathy, and other conditions. It is difficult to differentiate soft tissue infection from bone infection in the patient with diabetes and neuropathic bone disease. The precision of available tools for diagnosing osteomyelitis in patients with diabetes and foot ulcers is widely debated. A gold standard as a reference test for clinical trials and treatment decisions has not been consistently used in published research studies. Without a reference test that is reliable and valid, the conclusions regarding effectiveness of diagnostic modalities and antibiotic treatment regimens are questionable.

Orthopaedic infections.

Patients with orthopaedic infections may require admission to the intensive care unit (ICU). Necrotizing fasciitis and clostridial myonecrosis (gas gangrene) are serious soft tissue infections that may cause life-threatening complications. Patients suffering from infectious arthritis, osteomyelitis, or prosthetic joint infections may be seen in the ICU as a result of a previous injury, surgery, or delayed infectious processes. This article introduces the ICU nurse to the pathophysiology, clinical presentation, and management of a variety of orthopaedic infections.

An introduction to pediatric home health care.

PURPOSE: To provide an overview of the delivery of home health care services to pediatric patients. POPULATION: All pediatric patients. CONCLUSIONS: Institution-based nurses are integral in making referrals for home health care services and assuring home health care agencies have the needed information for providing seamless services. PRACTICE IMPLICATIONS: Institution-based nurses are the first line in the transition to home and are key members in making the transition happen without unnecessary difficulty for the child and family. This article presents pragmatic information about home health care agencies and how they operate so that institution-based nurses can maximize the benefit their pediatric patients receive from home health care.

Piomiositis de interaductores de cadera

La piomiositis es una infección del músculo esquelético, considerada no muy frecuente en áreas templadas pero sí en zonas tropicales. Sin embargo, en nuestra institución es una patología infecciosa poco usual, por tal razón, presentamos el caso de un paciente escolar hospitalizado en el servicio de infectología de la Clínica Infantil de Colsubsidio entre el 4 y 23 de septiembre de 1994 y en seguimiento posterior ambulatorio por infectología y ortopedia, en quien se llegó al diagnóstico de piomiositis de interaductores de cadera izquierda como foco primario; asociado luego a una osteomielitis de tibia derecha debidos a Staphylococcus aureus. El paciente tuvo una evolución favorable después del drenaje quirúrgico. No fue fácil establecer el diagnóstico definitivo sino después de cinco días de un gran consumo de recursos humanos, técnicos y económicos, así como de una gran expectativa del personal médico, paramédico, de la familia y del mismo paciente con el fin de tomar una conducta apropiada y oportuna que favoreciera el pronóstico del paciente. Nuestro objetivo es el de ilustrar con un caso una patología infecciosa no muy frecuente en nuestra institución, a pesar de estar en un área tropical, pero que debe considerarse en el diagnóstico diferencial del estudio del paciente con cuadro febril asociado a mialgias o limitación funcional sin un foco claro y el cual, tratado oportuna y adecuadamente, puede evitar complicaciones tardías y pronóstico reservado

The Papineau bone graft: a limb salvage technique.

The Papineau bone graft is a limb salvage technique that is an effective treatment alternative to amputation for problematic, infected nonunion of long bone. The graft technique involves radical open bone debridement, cancellous bone grafting over a granulation tissue base, delayed soft tissue closure, and immobilization of the affected extremity. A cooperative effort is necessary between the patient and health care team to ensure the success of the graft procedure. A case study is presented in this article detailing the care involved for a patient undergoing the Papineau procedure.