Diagnosis and management of osteomyelitis.

TLDR

Osteomyelitis is a bone infection that is acute and hematogenous in children, often caused by Staphylococcus aureus, and subacute or chronic in adults, typically following open injury and involving organisms such as Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, and Escherichia coli. Optimal treatment requires early, at least 4–6 weeks of parenteral antibiotics guided by evaluation, staging, and microbial susceptibility, with surgical debridement, dead‑space management, and bone stabilization as needed.

Abstract

Acute osteomyelitis is the clinical term for a new infection in bone. This infection occurs predominantly in children and is often seeded hematogenously. In adults, osteomyelitis is usually a subacute or chronic infection that develops secondary to an open injury to bone and surrounding soft tissue. The specific organism isolated in bacterial osteomyelitis is often associated with the age of the patient or a common clinical scenario (i.e., trauma or recent surgery). Staphylococcus aureus is implicated in most patients with acute hematogenous osteomyelitis. Staphylococcus epidermidis, S. aureus, Pseudomonas aeruginosa, Serratia marcescens and Escherichia coli are commonly isolated in patients with chronic osteomyelitis. For optimal results, antibiotic therapy must be started early, with antimicrobial agents administered parenterally for at least four to six weeks. Treatment generally involves evaluation, staging, determination of microbial etiology and susceptibilities, antimicrobial therapy and, if necessary, debridement, dead-space management and stabilization of bone.