Osteomyelitis

Cards (23)

  • Osteomyelitis refers to inflammation in a bone and bone marrow, usually caused by bacterial infection
  • Haematogenous osteomyelitis refers to when a pathogen is carried through the blood and seeded in the bone, which is the most common mode of infection
  • Osteomyelitis can occur due to direct contamination of the bone, for example, at a fracture site or during an orthopaedic operation
  • Staphylococcus aureus causes most cases of osteomyelitis
  • Osteomyelitis can be acute or chronic. Patients may develop recurring or chronic infections after treatment for acute osteomyelitis
  • Risk factors for developing osteomyelitis
    • Open fractures
    • Orthopaedic operations, particularly with prosthetic joints
    • Diabetes, particularly with diabetic foot ulcers
    • Peripheral arterial disease
    • IV drug use
    • Immunosuppression
  • Infection in a prosthetic joint is a big problem, occurring in around 1% of joint replacements. Extensive measures are taken to prevent it, such as perioperative prophylactic antibiotics. It is more likely to occur in revision surgery rather than during the initial joint replacement
  • Infection in a prosthetic joint occurs in around 1% of joint replacements
  • Extensive measures are taken to prevent infection in prosthetic joints, such as perioperative prophylactic antibiotics
  • Infection in a prosthetic joint is more likely to occur in revision surgery rather than during the initial joint replacement
  • Typical presentation of osteomyelitis
    • Fever
    • Pain and tenderness
    • Erythema
    • Swelling
  • The presentation of osteomyelitis can be quite non-specific, with generalised symptoms of infection such as fever, lethargy, nausea, and muscle aches
  • Potential signs of osteomyelitis on an x-ray
    • Periosteal reaction (changes to the surface of the bone)
    • Localised osteopenia (thinning of the bone)
    • Destruction of areas of the bone
  • Best imaging investigation for establishing a diagnosis of osteomyelitis
    MRI scans
  • Blood tests for osteomyelitis will show
    • Raised inflammatory markers (e.g., WBC, CRP, and ESR)
  • Blood cultures may be positive for the causative organism in osteomyelitis
  • Bone cultures can be performed to establish the causative organism and the antibiotic sensitivities in osteomyelitis
  • Management of osteomyelitis involves
    1. Surgical debridement of the infected bone and tissues
    2. Antibiotic therapy
  • Recommended antibiotic therapy for acute osteomyelitis
    • 6 weeks of flucloxacillin, possibly with rifampicin or fusidic acid added for the first 2 weeks
  • Alternatives to flucloxacillin for acute osteomyelitis
    • Clindamycin in penicillin allergy
    • Vancomycin or teicoplanin when treating MRSA
  • Chronic osteomyelitis usually requires 3 months or more of antibiotics
  • Osteomyelitis associated with prosthetic joints may require complete revision surgery to replace the prosthesis
  • Last updated
    August 2021