Osteomyelitis is an infection and inflammation of the bone. It can happen when a bacterial or fungal infection enters a bone from the bloodstream or surrounding tissue. Trauma to the skin, possibly from surgery, may be involved.

Osteomyelitis may develop quickly or over time. And about 2–5 per 10,000 people in the United States may have it.

The infection can occur at any age. Long bone infections, involving the arms or legs, are more common in children. But generally, older adults are more prone to osteomyelitis because they experience more health issues that can increase the risk of infections, such as diabetes or orthopedic problems that require surgery.

This article explores the types and treatments of osteomyelitis, as well as the signs and how to prevent it.

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Osteomyelitis may be “hematogenous,” stemming from the bloodstream, or non-hematogenous.

Hematogenous osteomyelitis involves an infection traveling to the bone from the bloodstream. It might develop if Staphylococcus aureus enters the body through IV treatment. It is more common in children.

Non-hematogenous osteomyelitis may result from trauma, such as a fracture or an open wound. Surgery may be responsible, especially if it involves a prosthetic material, such as metal pins, screws, or plates, which can carry bacteria or fungi.

When children develop non-hematogenous osteomyelitis, it most likely stems from trauma.

Diabetes and peripheral vascular disease (PVD) can make the treatment more challenging.

The symptoms of osteomyelitis can depend on the location of the infection, its severity, and the person’s age and general health.

They commonly include:

  • pain, which can be severe
  • swelling and tenderness in the affected area
  • irritability, lethargy, or fatigue
  • fever, chills, and sweating
  • drainage from an open wound near the infection or through the skin
  • skin discoloration
  • swelling of the ankles, feet, and legs
  • changes in walking, such as a limp, in children.

The best treatment depends on the severity of osteomyelitis, which may be acute or chronic.

Acute

Acute osteomyelitis develops quickly and can result from:

  • previous trauma
  • a puncture wound
  • surgery
  • a bone fracture
  • an abscessed tooth
  • any other infection involving soft tissue, the ears, or the sinuses

In children, osteomyelitis tends to be acute, and it usually develops within 2 weeks of a blood infection.

A delay in the diagnosis and treatment can lead to growth disturbances, malformation, and life threatening complications.

Treatment

This may involve a course of antibiotics or antifungal medication.

Adults may require up to 6 weeks of treatment, which may be IV or oral. A person may need to receive it in a hospital. Possible side effects of antibiotics include diarrhea, vomiting, and nausea.

If a drug-resistant strain of bacteria, such as methicillin-resistant S. aureus, or MRSA, has caused the infection, the treatment may take longer and require a combination of medications. The person may also need surgery, depending on the site or the source of the infection.

Chronic

Chronic osteomyelitis usually occurs after an acute episode if the treatment has not been entirely effective. However, it can develop without a known acute episode of osteomyelitis.

The symptoms are not always obvious, and they can resemble those of an injury. This can make a diagnosis more difficult, especially when the infection occurs in the hip, pelvis, or spine.

A person may experience bone pain, swelling, and tenderness, as well as color changes that may involve redness.

Treatment

Doctors recommend antibiotics for bacterial infections, as well as surgery to repair any bone damage and remove unhealthy areas.

In some cases, doctors may also recommend hyperbaric oxygen therapy to improve the penetration of some antibiotics and possibly to improve wound healing.

More specifically, the surgery may involve:

  • Draining: The surgeon may need to open up the area around the infected bone to drain any pus or fluid that has built up.
  • Surgical debridement: When osteomyelitis has destroyed some bone, the surgeon typically removes as much of this area as possible, plus a small margin of healthy bone, and any surrounding tissue with signs of infection. This is to ensure that all of the infection is removed.
  • Restoring blood flow to the bone: This is important if the infection has limited the flow of blood.
  • Removal of foreign objects: If necessary, the surgeon may need to take out prostheses, such as surgical plates or screws, from prior surgeries.

If the person is not well enough to have surgery, the doctor may rely on long-term IV antibiotics. They may reconsider surgery if this treatment is ineffective or the infection spreads from the bone into the bloodstream.

Osteomyelitis is difficult to treat. It often requires imaging, such as CT scans, surgery, and excellent wound care.

A person may go on to experience:

  • recurrent or relapsing infections
  • poor wound healing
  • side effects of antibiotics

PVD and immune-compromising conditions, such as diabetes, can make treating the infection even more difficult. Successful treatment requires a person to follow all guidance extremely carefully.

A person may be more likely to develop osteomyelitis if they:

Acute osteomyelitis is more common in children. Males and people over 50 are more likely to develop the infection in a vertebra.

A doctor first does an examination for signs such as tenderness and swelling. They also ask about the person’s recent medical history, particularly about accidents, operations, or infections.

They may then request:

  • Blood tests for:
  • Biopsy: The physician takes a small piece of tissue to test for the type of bacteria or fungi that is causing the infection. The type can determine the right treatment.
  • Imaging tests: An X-ray, MRI, or CT scan can reveal any bone damage.

The damage may not be visible for 2 weeks on an X-ray, so the more detailed scans are more effective for recent injuries.

The symptoms can differ from person to person. Overall, anyone with a weakened immune system who has any concerning symptoms should receive medical guidance.

To prevent osteomyelitis, doctors recommend:

  • avoiding injected illegal drugs
  • for people with diabetes, having prompt medical care for any issues involving the feet
  • for people with peripheral neuropathy, always wearing shoes, to prevent wounds