Osteomyelitis
Osteomyelitis is infection of bone acquired through the bloodstream, from adjacent tissue or by direct inoculation. It can progress to abscess, dead bone, sinus formation, vertebral neurological compromise or limb-threatening diabetic foot disease, so early cultures, imaging, specialist antibiotics and source control are central.
Definition
Osteomyelitis is infection of bone and marrow acquired through the bloodstream, by contiguous spread from adjacent tissue or by direct inoculation. It may be acute or chronic, with chronic disease often involving necrotic bone, sinus formation, biofilm or an infected implant.
First principles
The route of infection changes the presentation
Haematogenous infection commonly seeds the metaphysis of a child's long bone or the vertebral endplates and disc region in an adult. Contiguous infection arises from a diabetic foot ulcer, pressure injury or adjacent soft-tissue infection. Direct inoculation follows an open fracture, penetrating injury or surgery. Staphylococcus aureus is common, but the likely organisms and need for broad cover depend on age, site, exposures, immune status, prosthetic material and previous cultures.
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