Osteomyelitis

What is Osteomyelitis

Bone infections (osteomyelitis) occur when bacteria or other germs get inside a bone. This can happen if you have an infection in another part of your body that spreads through your blood.

Germs from your skin or from outside of your body can also cause this type of infection if you have a wound or a broken bone (fracture) that breaks the skin.

Bone infections need to be treated quickly to prevent bone damage and to prevent the infection from spreading to other areas of your body.

4 Interesting Facts of Osteomyelitis

1. Inflammation of bone caused by an infecting organism
2. Symptoms and physical findings are nonspecific and can include pain and limited range of motion of affected joint, similar to osteonecrosis 
3. Clinical signs (eg, fever, chills, fatigue, irritability) and/or laboratory findings (eg, positive blood cultures) consistent with infection and inflammation are usually present 
4. Definitive diagnosis is provided by bone biopsy with isolation of pathogens directly from the bone lesion

What are the causes?

Most bone infections are caused by bacteria. They can also be caused by other germs, such as viruses and funguses.

What increases the risk?

You are more likely to develop this condition if you:

• Recently had surgery, especially bone or joint surgery.
• Have a long-term (chronic) disease, such as:
  • Diabetes.
  • HIV (human immunodeficiency virus).
  • Rheumatoid arthritis.
  • Sickle cell anemia.
  • Kidney disease that requires dialysis.
• Are aged 60 years or older.
• Have a condition or take medicines that block or weaken your body’s defense system (immune system).
• Have a condition that reduces your blood flow.
• Have an artificial joint.
• Have had a joint or bone repaired with plates or screws (surgical hardware).
• Use IV drugs.
• Have a central line for IV access.
• Have had trauma, such as stepping on a nail or a broken bone that came through the skin.

What are the symptoms?

Symptoms vary depending on the type and location of your infection. Common symptoms of bone infections include:

• Fever and chills.
• Skin redness and warmth.
• Swelling.
• Pain and stiffness.
• Drainage of fluid or pus near the infection.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms and medical history.
• A physical exam.
• Tests, such as:
  • A sample of tissue, fluid, or blood taken to be examined under a microscope.
  • Pus or discharge swabbed from a wound for testing to identify germs and to determine what type of medicine will kill them (culture and sensitivity).
  • Blood tests.
• Imaging studies. These may include:
  • X-rays.
  • MRI.
  • CT scan.
  • Bone scan.
  • Ultrasound.

How is this treated?

Treatment for this condition depends on the cause and type of infection. Antibiotic medicines are usually the first treatment for a bone infection. This may be done in a hospital at first. You may have to continue IV antibiotics at home or take antibiotics by mouth for several weeks after that.

Other treatments may include surgery to remove:

• Dead or dying tissue from a bone.
• An infected artificial joint.
• Infected plates or screws that were used to repair a broken bone.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Take your antibiotic medicine as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Follow instructions from your health care provider about how to take IV antibiotics at home. You may need to have a nurse come to your home to give you the IV antibiotics.

General instructions

• Ask your health care provider if you have any restrictions on your activities.
• If directed, put ice on the affected area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Wash your hands often with soap and water. If soap and water are not available, use hand sanitizer.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You develop a fever or chills.
• You have redness, warmth, pain, or swelling that returns after treatment.

Get help right away if:

• You have rapid breathing or you have trouble breathing.
• You have chest pain.
• You cannot drink fluids or make urine.
• The affected area swells, changes color, or turns blue.
• You have numbness or severe pain in the affected area.

Summary

• Bone infections (osteomyelitis) occur when bacteria or other germs get inside a bone.
• You may be more likely to get this type of infection if you have a condition, such as diabetes, that lowers your ability to fight infection or increases your chances of getting an infection.
• Most bone infections are caused by bacteria. They can also be caused by other germs, such as viruses and funguses.
• Treatment for this condition usually starts with taking antibiotics. Further treatment depends on the cause and type of infection.