A common mechanism of osteomyelitis in pediatric patients is hematogenous spread, which has a different pathogenesis. This paper was directed at other mechanisms for osteomyelitis.
Causes of infected contiguous soft tissue may include:
(1) decubital ulcer
(2) puncture wound
(3) paronchyia
General risk factors:
(1) inadequate initial antibiotic therapy (inappropriate antibiotic choice, inadequate dose, insufficient duration of therapy)
(2) vascular insufficiency
(3) presence of devitalized bone and/or adjacent soft tissue (due to either inadequate debridement or subsequent injury)
(4) nosocomial bacteremia with hematogenous spread, especially if there is devitalized tissue present
(5) presence of Staphylococcus aureus (Table 5, page 32)
(6) presence of antibiotic-resistant bacteria
Risk factors following trauma:
(1) fixation of a long bone fracture
(2) severe open (compound) fracture
Risk factors associated with infected contiguous soft tissue:
(1) ongoing infection in contiguous soft tissue
Cultures taken from skin wounds or draining sinuses often do not correlate with isolates from bone cultures.
