SHM's Clinical Quick Talks-Osteomyelitis

Pdf Summary

Osteomyelitis is an infection of the bone that can be spread either through direct contamination or through the bloodstream. It is characterized by subacute to chronic pain, slow-healing wounds, and the development of sinus tracts. Fever and systemic symptoms may not be present unless the infection is acute and spread through the bloodstream. Diagnosis is typically made based on clinical findings, such as the physical exam and the use of Wagner's Classification of Diabetic Foot Ulcers. Radiology, including X-ray and MRI, can provide additional information, but may have limitations. Microbiology involves bone biopsy and surgical debridement, although pre-treatment with antibiotics can decrease the yield of cultures. Diabetic individuals, intravenous drug users, and those with sickle cell disease are at higher risk for osteomyelitis and may require specific considerations in diagnosis and treatment. Treatment often involves 4-6 weeks of targeted parenteral therapy based on culture results, with factors such as infection duration, hardware presence or removal, and antibiotic characteristics impacting the duration of treatment. The OVIVA trial showed non-inferiority of oral antibiotics compared to parenteral antibiotics, but further data is needed. The decision to use oral antibiotics should consider patient-specific factors, such as cost and adherence. Bone biopsies and cultures should be obtained unless the patient is systemically ill. Deep-seated infections with abscess or sinus tracts may benefit from surgical debridement. Overall, the management of osteomyelitis requires a multidisciplinary approach and consideration of individual patient factors.

Asset Subtitle

Cindy Glickman, Maura Porto

Keywords

Osteomyelitis

bone infection

direct contamination

bloodstream spread

subacute pain

chronic pain

slow-healing wounds

sinus tracts

fever

systemic symptoms