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Osteomyelitis

Bone infection; Infection - bone

 

Osteomyelitis is a bone infection that is caused by bacteria or other germs.

Causes

 

Bone infection is most often caused by bacteria. It can also be caused by fungi or other germs.

When a person has osteomyelitis:

  • Bacteria or other germs may spread to a bone from infected skin, muscles, or tendons next to the bone. This may occur under a skin sore.
  • The infection can start in another part of the body and spread through the blood to the bone.
  • The infection can also start after bone surgery. This is more likely if the surgery is done after an injury or if metal rods or plates are placed in the bone.

In children, the long bones of the arms or legs are most often involved. In adults, the feet, spine bones (vertebrae), and hips (pelvis) are most commonly affected.

Risk factors are:

  • Diabetes
  • Hemodialysis
  • Poor blood supply
  • Recent injury
  • Use of injected illegal drugs

People who have had their spleen removed are also at higher risk of osteomyelitis.

 

Symptoms

 

Symptoms may include the following:

  • Bone pain
  • Excessive sweating
  • Fever and chills
  • General discomfort, uneasiness, or ill feeling (malaise)
  • Local swelling, redness, and warmth
  • Pain at the site of infection
  • Swelling of the ankles, feet, and legs

 

Exams and Tests

 

The health care provider will perform a physical examination and ask about the symptoms you're having.

Tests that may be ordered include:

  • Blood cultures
  • Bone biopsy (the sample is cultured and examined under a microscope)
  • Bone scan
  • Bone x-ray
  • Complete blood count (CBC)
  • C-reactive protein (CRP)
  • Erythrocyte sedimentation rate (ESR)
  • MRI of the bone
  • Needle aspiration of the area of the affected bones

 

Treatment

 

The goal of treatment is to stop the infection and reduce damage to the bone and surrounding tissues.

Antibiotics are given to destroy the bacteria causing the infection:

  • You may receive more than one antibiotic at a time.
  • Antibiotics are taken for at least 4 to 6 weeks, often at home through an IV (intravenously, meaning through a vein).

Surgery may be needed to remove dead bone tissue if you have an infection that does not go away:

  • If there are metal plates near the infection, they may need to be removed.
  • The open space left by the removed bone tissue may be filled with bone graft or packing material. This promotes the growth of new bone tissue.

Infection that occurs after joint replacement may require surgery to remove the replaced joint and infected tissue in the area. A new prosthesis may be implanted in the same operation. More often, doctors wait until the infection has gone away.

If you have diabetes, it will need to be well controlled. If there are problems with blood supply to the infected area, such as the foot, surgery to improve blood flow may be needed to get rid of the infection.

If you were treated in the hospital for your osteomyelitis, be sure to follow instructions on how to care for yourself at home.

 

Outlook (Prognosis)

 

With treatment, the outcome for acute osteomyelitis is usually good.

The outlook is worse for those with long-term (chronic) osteomyelitis. Symptoms may come and go for years, even with surgery. Amputation may be needed, especially in people with diabetes or poor blood circulation.

The outlook for people with an infection of a prosthesis depends partly on:

  • The person's health
  • The type of infection
  • Whether the infected prosthesis can be safely removed

 

When to Contact a Medical Professional

 

Call your health care provider if:

  • You develop symptoms of osteomyelitis
  • You have osteomyelitis and the symptoms continue, even with treatment

 

 

References

Berbari EF, Steckelberg JM, Osmon DR. Osteomyelitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 106.

Dabov GD. Osteomyelitis. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. Philadelphia, PA: Elsevier Mosby; 2013:chap 21.

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      Review Date: 5/1/2015

      Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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