A child is admitted to the hospital several days after stepping on a sharp object that punctured her athletic shoe and entered the flesh of her foot. The physician is concerned about osteomyelitis and has ordered parenteral antibiotics. Which of the following actions is done immediately before the antibiotic is started?
A. The admission orders are written.
B. A blood culture is drawn.
C. A complete blood count with differential is drawn.
D. The parents arrive.
Correct Answer: B. A blood culture is drawn.
Antibiotics must be started after the blood culture is drawn, as they may interfere with the identification of the causative organism. Prolonged antibiotic therapy is the cornerstone of treatment for osteomyelitis. Results of culture and sensitivity should guide antibiotic treatment if possible, but in the absence of this data, it is reasonable to start empiric antibiotics.
Option A: Physician’s order for the antibiotics must be written before administration of the antibiotics. A commonly used broad-spectrum empiric antibiotic regimen against both gram-positive and negative organisms including MRSA is vancomycin (15 mg/kg intravenously [IV] every 12 hours) plus a third a generation cephalosporin (e.g., ceftriaxone 2 gm IV daily) or a beta-lactam/beta-lactamase inhibitor combination (e.g., piperacillin/tazobactam 3.375 IV every 8 hours).
Option C: The blood count will reveal the presence of infection but does not help identify an organism or guide antibiotic treatment. Laboratory data can be useful in the assessment of osteomyelitis but are usually nonspecific for osteomyelitis. There may or may not be leukocytosis, elevation of ESR, and C-reactive protein (CRP). The CRP level correlates with clinical response to therapy and may be used to monitor treatment. Blood cultures may be positive, especially in hematogenous osteomyelitis involving the vertebrae, clavicle, or pubis.
Option D: Parental presence is important for the adjustment of the child but not for the administration of medication. qualified home-bound patients benefit from home health wound nurse visits several times a week, while those who are ambulatory are encouraged to use wound care clinics if available. Family members and caregivers are also an integral part of the care team, providing support and care between healthcare provider visits. Only through such an approach can the morbidity of osteomyelitis be decreased.