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Osteomyelitis

Common Causes and Treatment Recommendations

  • Practical Therapeutics
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Summary

Infections involving bone continue to be a common problem. In children this is usually an acute haematogenous osteomyelitis. Early diagnosis with culture of an aspiration specimen is of paramount importance. Treatment with antibacterial agents is often successful unless pus is obtained in aspiration. In cases with an established abscess, surgical drainage is often needed in addition to antibiotic treatment.

Staphylococcus aureus is the most common causative organism, although other microbes are often found in special circumstances such as in neonates, patients with sickle cell disease and those with nail puncture wounds.

In adults, a pyogenic osteomyelitis is often due to direct trauma and generally is chronic in nature. Surgical debridement is the mainstay of treatment in these cases. Antibiotic treatment is often helpful but not curative by itself.

Fungal and mycobacterial osteomyelitis is especially common in immunocompromised hosts. Amphotericin B remains the preferred treatment for fungal infections. Long term antituberculous multiple drug therapy is often sufficient to treat mycobacterial osteomyelitis.

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References

  • Almekinders LC, Greene WB. Vertebral Candida infections. Case report and review of the literature. Clinical Orthopaedics and Related Research 267: 174–178, 1991

    PubMed  Google Scholar 

  • Almekinders LC, Lachiewicz PF. Nocardia osteomyelitis: case report and review of the literature. Orthopaedics 12: 1583–1585, 1989

    CAS  Google Scholar 

  • Bell SM. Further observations on the value of oral penicillins in chronic staphylococcal osteomyelitis. Medical Journal of Australia 2: 591, 1976

    PubMed  CAS  Google Scholar 

  • Black J, Hunt TL, Godley PJ, Matthew E. Oral antimicrobial therapy for adults with osteomyelitis or septic arthritis. Journal of Infectious Diseases 155: 968, 1987

    Article  PubMed  CAS  Google Scholar 

  • Blockley NJ, Watson JT. Acute osteomyelitis in children. Journal of Bone and Joint Surgery 52B: 77, 1970

    Google Scholar 

  • Borman TR, Johnson RA, Sherman FC. Gallium scintigraphy for diagnosis of septic arthritis and osteomyelitis in children. Journal of Paediatric Orthopaedics 6: 317, 1986

    Article  CAS  Google Scholar 

  • Brennan PJ, Degirolamo MP. Musculoskeletal infections in immunocompromised hosts. Orthopaedic Clinics of North America 22: 389, 1991

    CAS  Google Scholar 

  • Bryson VJ, Connor JD, Leclere M, Giammona ST. High dose oral dicloxacillin treatment of acute staphylococcal osteomyelitis in childhood. Journal of Pediatrics 94: 673, 1979

    Article  PubMed  CAS  Google Scholar 

  • Burch FH, Fine G, Quinn EL, Eisses JF. Cryptococcus neoformans as a cause of lytic bone lesions. Journal of the American Medical Association 231: 1057–1059, 1975

    Article  PubMed  CAS  Google Scholar 

  • Canale ST, Harkness RM, Thomas PA, Massie JD. Does aspiration of bones and joints affect results of later bone scanning. Journal of Paediatric Orthopaedics 5: 23, 1985

    Article  CAS  Google Scholar 

  • Chapman SW. Blastomyces dermatitides. In Mandell et al. (Eds) Principles and practices of infectious diseases, 2nd ed., pp. 1477–1485, Wiley, New York, 1985

    Google Scholar 

  • Christensen GD, Simpson WA. Gram positive bacteria: pathogenesis of staphylococcal musculoskeletal infections. In Esterhai et al. (Eds) Musculoskeletal infection, pp. 57–78, American Academy of Orthopaedic Surgeons, Park Ridge II, 1992

    Google Scholar 

  • Cierny III G. Classification and treatment of adult osteomyelitis. In Evarts (Ed.) Surgery of the musculoskeletal system, 2nd ed., Vol. 5, pp. 4337–4380, Churchill Livingstone, London, 1990

    Google Scholar 

  • Clark RB, Spector H, Friedman OM, Oldrati KJ, Young CL, et al. Osteomyelitis and synovitis produced by Mycobacteriumarinum in a fisherman. Journal of Clinical Microbiology 28: 2570–2572, 1990

    PubMed  CAS  Google Scholar 

  • Clawson KK, Davis FT, Hansen ST. Treatment of chronic osteomylelitis with emphasis on closed suction-irrigration technique. Clinical Orthopaedics and Related Research 96: 88, 1973

    Article  PubMed  Google Scholar 

  • Cole WG, Dalziel RE, Leitl S. Treatment of acute osteomyelitis in childhood. Journal of Bone and Joint Surgery 64B: 218, 1982

    Google Scholar 

  • Dankett J, Hogt AH, Feijen T. Biomedical polymers: bacterial adhesion, colonization and infection. CRC Critical Review of Biocompatibility 2: 219, 1986

    Google Scholar 

  • Dougherty SLT, Simmens RL. Infections in bionic man: the pathology of infections in prosthetic devices. Current Problems in Surgery 19: 265, 1982

    PubMed  CAS  Google Scholar 

  • Edwards JE. Severe candidal infections: clinical perspective, immune defense mechanisms and current concepts of therapy. Annals of Internal Medicine 89: 91–106, 1978

    PubMed  Google Scholar 

  • Feigin RD, Pickering LK, Anderson D, Keeney RD, Shackleford PG. Clindamycin treatment of osteomyelitis an septic arthritis in children. Pediatrics 55: 213, 1975

    PubMed  CAS  Google Scholar 

  • Fisher MC, Goldsmith JF, Gilligan PH. Sneakers as a source of Pseudomonas aeruginosa in children with osteomyelitis following puncture wounds. Journal of Pediatrics 106: 607, 1985

    Article  PubMed  CAS  Google Scholar 

  • Fitzgerald RH, Conan JD. Puncture wounds of the foot. Orthopaedic Clinics of North American: 965, 1975

  • Fox L, Sprant K. Neonatal osteomyelitis. Pediatrics 62: 535, 1978

    PubMed  CAS  Google Scholar 

  • Gallin, JI. (Moderator). Clinical manifestations: recent advances in chronic granulomatous disease. Annals of Internal Medicine 99: 657, 1983

    PubMed  CAS  Google Scholar 

  • Gentry LO, Rodriguez GG. Oral ciprofloxacin compared with parenteral antibiotics in the treatment of osteomyelitis. Antimicrobial Agents and Chemotherapy 34: 40, 1990

    Article  PubMed  CAS  Google Scholar 

  • Gentry LO, Rodriguez G. Ofloxacin versus parenteral therapy for chronic osteomyelitis. Antimicrobial agents and chemotherapy 35: 538, 1991

    Article  PubMed  CAS  Google Scholar 

  • Givner LB, Luddy RE, Schwartz AD. Etiology of osteomyelitis in patients with major sickle hemoglobinopathies. Journal of Pediatrics 99: 411, 1981

    Article  PubMed  CAS  Google Scholar 

  • Grange JM. Bacteriology of mycobacteria. In Coombs & Fitzgerald (Eds) Infection in the orthopaedic patient, pp. 297–302, Butterworths, London, 1989

    Google Scholar 

  • Green N, Bruno J. Pseudomonas infections of the foot after puncture wounds. Southern Medical Journal 73: 146, 1980

    Article  PubMed  CAS  Google Scholar 

  • Green NE. The use of bone scans for the detection of osteomyelitis. Instructional Course Lectures 32: 40, 1983

    PubMed  CAS  Google Scholar 

  • Green NE, Edwards K. Bone and joint infections in children. Orthopaedic Clinics of North America 18: 555, 1987

    CAS  Google Scholar 

  • Gristina AG, Naylor PT, Myrvik GN. Mechanisms of musculoskeletal sepsis. Orthopaedic Clinics of North America 22: 363, 1991

    CAS  Google Scholar 

  • Grossman M. Aspergillosis of bone. British Journal Radiology 18: 57–59, 1975

    Article  Google Scholar 

  • Gustilo RB, Mendoza RM, Williams DN. Problems in the management of Type lll open fractures. A new classification of Type lll open fractures. Journal of Trauma 24: 742, 1984

    Article  PubMed  CAS  Google Scholar 

  • Gustilo RB. Management of infected fratures. In Evarts (Ed.) Surgery of the musculoskeletal system, 2nd ed., Vol. 5. pp. 4429–4453, Churchill Livingstone, London, 1990a

    Google Scholar 

  • Gustilo RB. Management of infected non-union. In Evarts (Ed.) Surgery of the musculoskeletal system, 2nd ed., Vol. 5, pp. 4455–4474, Churchill Livingstone, London, 1990b

    Google Scholar 

  • Harris RL, Fainstein V, Elting L, Hopfer RL, Bodey GP. Bacteraemia caused by Aeromonas species in hospitalized cancer patients. Review of Infectious Diseases 7: 314, 1985

    Article  CAS  Google Scholar 

  • Heydemann JS, Morrissy RT. Bone and joint sepsis in childhood: problems in diagnosis. Orthopaedic Transactions 10: 504, 1986

    Google Scholar 

  • Hobo T. Zur Pathogenesis for akuten hematogenous osteomyelitis. Medicinals universities imperialis in Kioto. Acta Scholae 4: 1, 1921

    Google Scholar 

  • Ingram C, Eran LJ, Goldenberg RT, Morrison AJ, Poretz DM, et al. Antibiotic treatment of osteomyelitis in outpatients. Medical Clinics of North America 72: 723, 1988

    PubMed  CAS  Google Scholar 

  • Jackson MA, Nelson JD. Etiology and medical management of acute suppurative bone and joint infections in paediatric patients. Journal of Paediatric Orthopaedics 2: 313, 1982

    CAS  Google Scholar 

  • Jacobs RF, Adelman L, Sack CM, Wilson CB. Management of pseudomonas osteochondritis complicating puncture wounds of the foot. Pediatrics 69: 432, 1982

    PubMed  CAS  Google Scholar 

  • Jacobs RF, McCarthy RE, Elser JM. Pseudomonas osteochondritis complicating puncture wounds of the foot in children: a 10-year evaluation. Journal of Infectious Disease 160: 657, 1989

    Article  CAS  Google Scholar 

  • Jindari A, Aber V, Edwards EA, Mutchison DA. The early bactericidal activity of drugs in patients with pulmonary tuberculosis. American Review of Respiratory Diseases 121: 939–944, 1980

    Google Scholar 

  • Johnston CLW, Webster ADB, Taylor-Robinson D, Rapaport G, Hughes GRV. Primary late-onset hypogammaglobulinemia associated with inflammatory polyarthritis and septic arthritis due to mycoplasma pneumonia. Annals of Rheumatic Disease 42: 108, 1983

    Article  CAS  Google Scholar 

  • Keeley K, Buchanan GR. Acute infarction of long bones in children with sickle cell anemia. Journal of Pediatrics 101: 170, 1982

    Article  PubMed  CAS  Google Scholar 

  • Kolyvas E, Ahronheim G, Marks MI, Gledhill R, Owen H, et al. Oral antibiotic therapy of skeletal infections in children. Pediatrics 65: 867, 1980

    PubMed  CAS  Google Scholar 

  • Kuo KN, Lloyd-Roberts GC, Orme IM, Soothill JF. Immunodeficiency and infantile bone and joint infection. Archives of Diseases of Children 50: 51, 1975

    Article  CAS  Google Scholar 

  • Lopez JF, Quesed J, Saied A. Bacteraemia and osteomyelitis due to Aeromonas hydrophilia: a complication during the treatment of acute leukemia. American Journal Clinical Pathology 50: 587, 1968

    CAS  Google Scholar 

  • Lunke RT, Fitzgerald RH, Washington JA. Pharmacokinetics of cefamandole in osseous tissue. Antimicrobial Agents Chemotherapy 19: 851, 1981

    Article  CAS  Google Scholar 

  • Mader JT, Cantell JS, Calhoun J. Oral ciprofloxacin compared with standard parenteral antibiotic therapy for chronic osteomyelitis in adults. Journal of Bone and Joint Surgery 72–104, 1990

  • MacGregor RR. Host defenses, the compromised host and osteomyelitis. In Esterhai et al. (Eds) Muscoloskeletal infection, pp. 291–297, American Academy of Orthopaedic Surgeons, Park Ridge, II, 1992

    Google Scholar 

  • Mallouh A, Talab Y. Bone and joint infection in patients with sickle cell disease. Journal of Paediatric Orthopaedics 5: 158, 1985

    CAS  Google Scholar 

  • Masters DL, Lentino JR. Cervical osteomyelitis related to nocardia asteroides. Journal of Infectious Diseases 149: 824, 1984

    Article  PubMed  CAS  Google Scholar 

  • McCoy JR, Morrissy RT, Siebert J. Clinical experience with the technetium scan in children. Clinical Orthopaedics and Related Research 154: 175, 1981

    PubMed  Google Scholar 

  • Medical Research Council’s Working Party on Tuberculosis of the Spine. Short course chemotherapy in the treatment of spinal tuberculosis. Journal of Bone and Joint Surgery 68B: 158, 1986

    Google Scholar 

  • Menan J, Bowen TM, Neri C. Long term outpatient intravenous antibiotic therapy for orthopaedic patients. Orthopaedics 7: 1280, 1984

    Google Scholar 

  • Mitchison DA. The action of anti-tuberculosis drugs in short course chemotherapy. Tubercle 66: 219–255, 1985

    Article  PubMed  CAS  Google Scholar 

  • Morrey BF, Peterson HA. Hematogenous pyogenic osteomyelitis in children. Orthopaedic Clinics of North America 6: 935, 1975

    CAS  Google Scholar 

  • Morrissy RT. Bone and joint sepsis in children. Instructional Course Lectures 31: 49, 1982

    PubMed  CAS  Google Scholar 

  • Morrissy RT, Haynes DW. Acute hematogenous osteomyelitis. Journal of Paediatric Orthopaedics 9: 447, 1989

    CAS  Google Scholar 

  • Morrissy RT. Bone and joint infections. In Morrissy (Ed.) Lovell and Winter’s paediatric orthopaedics, 3rd ed., Vol. 1, pp. 539–561, J.B. Lippincott Company, Philadelphia, 1990

    Google Scholar 

  • Nelson JD. The bacterial etiology and antibiotic management of septic arthritis in infants and children. Pediatrics 50: 437, 1972

    PubMed  CAS  Google Scholar 

  • Ninth Report of the Medical Research Council Working Party on Tuberculosis of the Spine. A 10 year assessment of controlled clinical trials of inpatient and outpatient treatment and of plaster-of-paris treatment for tuberculosis of the spine in children on standard chemotherapy: studies in Masan and Pausan, Korea. Journal of Bone and Joint Surgery 67B: 103–110, 1985.

    Google Scholar 

  • O’Brien T, McManns F, MacAuley PH, Ennis JT. Acute hematogenous osteomyelitis. Journal of Bone and Joint Surgery 64B: 450, 1982

    Google Scholar 

  • Patzakis MJ, Harrey JP, Ivler D. The role of antibiotics in the management of open fractures. Journal of Bone and Joint Surgery 56: 532, 1974

    PubMed  CAS  Google Scholar 

  • Peltola H, Vahvanen V. A comparative study of osteomyelitis and purulent arthritis with special reference to aetiology and recovery. Infection 12: 75, 1984

    Article  PubMed  CAS  Google Scholar 

  • Peterson PK, Tsukayama DT. Bone and joint infections in immunocompromited patients. In Gustilo (Ed.) Orthopaedic infection: diagnosis and treatment, pp. 81–86, W.B. Saunders Company, Philadelphia, 1989

    Google Scholar 

  • Prober CG, Yeager AS. Use of serum bactericidal titer to assess the adequacy of oral antibiotic therapy in the treatment of acute hematogenous osteomyelitis. Paediatric Pharmacology and Therapeutics 95: 131, 1979

    CAS  Google Scholar 

  • Rao S, Solomon W, Miller S, Dunn E. Scintigraphic differentiation of bone infarction from osteomyelitis. Journal of Pediatrics 107: 685, 1986

    Google Scholar 

  • Roca RP, Yoshikawa TT. Primary skeletal infectious in heroin users. Clinical Orthopaedics and Related Research 144: 238, 1979

    PubMed  Google Scholar 

  • Scoles PV, Aronoll SC. Antimicrobial therapy of childhood skeletal infections. Journal of Bone and Joint Surgery 66A: 1487, 1984

    Google Scholar 

  • Squire G, Farara B, Todd J. Diagnosis of neonatal bacterial infection. Pediatrics 64: 60, 1979

    PubMed  CAS  Google Scholar 

  • Sullivan JA, Vasilell T, Leonard JC. An evaluation of nuclear scanning in orthopaedic infections. Journal of Paediatric Orthopaedics 1: 73, 1981

    Article  CAS  Google Scholar 

  • Tack KJ, Rhame FS, Brown B, Thompson RC. Aspergillus osteomyelitis: report of four cases and review of the literature. American Journal of Medicine 73: 295, 1982

    Article  PubMed  CAS  Google Scholar 

  • Tauber AI, Berregaard N, Simens E, Wright J. Chronic granulomatous disease: a syndrome of phagocyte oxidase deficiencies. Medicine 62: 286, 1983

    Article  PubMed  CAS  Google Scholar 

  • Tetzlaff TR, Howard JB, McCracken GH. Antibiotic concentrations in pus and bone of children with osteomyelitis. Journal of Pediatrics 92: 135, 1978

    Article  PubMed  CAS  Google Scholar 

  • Tetzlaff TR, McCracken GH, Nelson JD. Oral antibiotic therapy for skeletal infections of children. Paediatric Pharmacology and Therapeutics 92: 485, 1978

    CAS  Google Scholar 

  • Wagner DK, Collier D, Rytel MW. Long-term intravenous antibiotic therapy in chronic osteomyelitis. Archives of Internal Medicine. 145: 1073, 1985

    Article  PubMed  CAS  Google Scholar 

  • Wald ER, Mirro R, Gartner SC. Pitfalls in the diagnosis of acute osteomyelitis by bone scan. Clinical Pediatrics 19: 597, 1980

    Article  PubMed  CAS  Google Scholar 

  • Webster ADB, Taylor-Robinson D, Furr PM, Asherson GL. Mycoplasma septic arthritis in hypogammaglobulinemia. British Medical Journal 1: 478, 1978

    Article  PubMed  CAS  Google Scholar 

  • Weinstein MP, Stratton CW, Hawley HB, Ackley A, Relier LB. Multicenter collaborative evaluation of a standardized serum bacterial test as a predictor of therapeutic efficiency in acute and chronic osteomyelitis. American Journal of Medicine 83: 218, 1987

    Article  PubMed  CAS  Google Scholar 

  • Zimmerman III B, Erickson AD, Mikolich DT. Septic acramioclavicular arthritis and osteomyelitis in a patient with acquired immunodeficiency syndrome. Arthritis and Rheumatology 32: 11–55, 1989

    Google Scholar 

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  1. Division of Orthopaedics, University of North Carolina, 250 Burnett-Womack Building CB#7055, Chapel Hill, North Carolina, NC 27599-7055, USA

    Douglas R. Dirschl &  Louis C. Almekinders

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  1. Douglas R. Dirschl
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Dirschl, D.R., Almekinders, L.C. Osteomyelitis. Drugs 45, 29–43 (1993). https://doi.org/10.2165/00003495-199345010-00004

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