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Hematogenous osteomyelitis in adults

Steven K Schmitt, MD, FIDSA
Mark E Shirtliff, PhD
Section Editor
Daniel J Sexton, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Hematogenous osteomyelitis accounts for approximately 20 percent of cases of osteomyelitis in adults. It occurs more frequently in males. Hematogenous osteomyelitis most commonly involves the vertebral bones; the next most common sites are the flat bones of the axial skeleton, such as the clavicle and pelvis. Less frequently, the long bones of the appendicular skeleton can be involved [1].

Hematogenous osteomyelitis in adults will be reviewed here. Hematogenous osteomyelitis in children is discussed separately. (See "Hematogenous osteomyelitis in children: Epidemiology, pathogenesis, and microbiology" and "Hematogenous osteomyelitis in children: Clinical features and complications" and "Hematogenous osteomyelitis in children: Evaluation and diagnosis" and "Hematogenous osteomyelitis in children: Management".)

Hematogenous osteomyelitis may occur in conjunction with hematogenous seeding of indwelling medical devices including prosthetic joints and other orthopedic implants. Issues related to these types of infections are discussed separately. (See "Prosthetic joint infection: Treatment" and "Prosthetic joint infection: Epidemiology, clinical manifestations, and diagnosis" and "Prevention of prosthetic joint and other types of orthopedic hardware infection".)


Hematogenous osteomyelitis is primarily a disease of children, with 85 percent of cases occurring in patients younger than 17 years of age [2]. The proportion of adult cases may be increasing as the mean age of the population rises in the United States and developed countries [3].

Most cases in adults are observed in patients over age 50, with the exception of intravenous drug users, the majority of whom are under age 40 [4]. Hematogenous osteomyelitis is also associated with other risk factors for bacteremia (eg, central lines, dialysis, sickle cell disease, urethral catheterization, urinary tract infection).

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Literature review current through: Nov 2017. | This topic last updated: Nov 22, 2016.
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