Hematogenous osteomyelitis in adults
- Steven K Schmitt, MD, FIDSA
Steven K Schmitt, MD, FIDSA
- Staff Physician, Department of Infectious Diseases
- Associate Professor of Medicine
- Cleveland Clinic Lerner College of Medicine
- Mark E Shirtliff, PhD
Mark E Shirtliff, PhD
- Assistant Professor
- University of Maryland
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 .
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 . The proportion of adult cases may be increasing as the mean age of the population rises in the United States and developed countries .
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 . Hematogenous osteomyelitis is also associated with other risk factors for bacteremia (eg, central lines, dialysis, sickle cell disease, urethral catheterization, urinary tract infection).To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004; 364:369.
- Mader JT, Shirtliff M, Calhoun JH. The host and the skeletal infection: classification and pathogenesis of acute bacterial bone and joint sepsis. Baillieres Best Pract Res Clin Rheumatol 1999; 13:1.
- Espersen F, Frimodt-Møller N, Thamdrup Rosdahl V, et al. Changing pattern of bone and joint infections due to Staphylococcus aureus: study of cases of bacteremia in Denmark, 1959-1988. Rev Infect Dis 1991; 13:347.
- Chandrasekar PH, Narula AP. Bone and joint infections in intravenous drug abusers. Rev Infect Dis 1986; 8:904.
- Fernandez M, Carrol CL, Baker CJ. Discitis and vertebral osteomyelitis in children: an 18-year review. Pediatrics 2000; 105:1299.
- Gordon RJ, Lowy FD. Bacterial infections in drug users. N Engl J Med 2005; 353:1945.
- Zalavras CG, Rigopoulos N, Lee J, et al. Magnetic resonance imaging findings in hematogenous osteomyelitis of the hip in adults. Clin Orthop Relat Res 2009; 467:1688.
- Waldvogel FA, Medoff G, Swartz MN. Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects. N Engl J Med 1970; 282:198.
- Calhoun JH, Manring MM, Shirtliff M. Osteomyelitis of the long bones. Semin Plast Surg 2009; 23:59.
- Ham KN, Hurley JV, Ryan GB, Storey E. Localization of particulate carbon in metaphyseal vessels of growing rats. Aust J Exp Biol Med Sci 1965; 43:625.
- Anderson CE, Parker J. Invasion and resorption in enchondral ossification. An electron microscopic study. J Bone Joint Surg Am 1966; 48:899.
- Emslie KR, Nade S. Pathogenesis and treatment of acute hematogenous osteomyelitis: evaluation of current views with reference to an animal model. Rev Infect Dis 1986; 8:841.
- Hobo, T. Zur pathogenese de akuten haematatogenen Osteomyelitis, mit Beruckishtigun der Vitalfarbungslehre. Acta Sch Med Univ Imp Kioto 1922; 4:1.
- Patti JM, Allen BL, McGavin MJ, Höök M. MSCRAMM-mediated adherence of microorganisms to host tissues. Annu Rev Microbiol 1994; 48:585.
- Mader JT, Ortiz M, Calhoun JH. Update on the diagnosis and management of osteomyelitis. Clin Podiatr Med Surg 1996; 13:701.
- Waldvogel FA, Medoff G, Swartz MN. Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects (second of three parts). N Engl J Med 1970; 282:260.
- Waldvogel FA, Medoff G, Swartz MN. Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects. 3. Osteomyelitis associated with vascular insufficiency. N Engl J Med 1970; 282:316.
- Burnett MW, Bass JW, Cook BA. Etiology of osteomyelitis complicating sickle cell disease. Pediatrics 1998; 101:296.
- Holzman RS, Bishko F. Osteomyelitis in heroin addicts. Ann Intern Med 1971; 75:693.
- Pertuiset E, Beaudreuil J, Lioté F, et al. Spinal tuberculosis in adults. A study of 103 cases in a developed country, 1980-1994. Medicine (Baltimore) 1999; 78:309.
- Garbino J, Schnyder I, Lew D, et al. An unusual cause of vertebral osteomyelitis: Candida species. Scand J Infect Dis 2003; 35:288.
- Miller DJ, Mejicano GC. Vertebral osteomyelitis due to Candida species: case report and literature review. Clin Infect Dis 2001; 33:523.
- Hendrickx L, Van Wijngaerden E, Samson I, Peetermans WE. Candidal vertebral osteomyelitis: report of 6 patients, and a review. Clin Infect Dis 2001; 32:527.
- Rolain JM, Chanet V, Laurichesse H, et al. Cat scratch disease with lymphadenitis, vertebral osteomyelitis, and spleen abscesses. Ann N Y Acad Sci 2003; 990:397.
- Caraway NP, Fanning CV, Stewart JM, et al. Coccidioidomycosis osteomyelitis masquerading as a bone tumor. A report of 2 cases. Acta Cytol 2003; 47:777.
- Holley K, Muldoon M, Tasker S. Coccidioides immitis osteomyelitis: a case series review. Orthopedics 2002; 25:827.
- Do TT, Strub WM, Witte D. Subacute Propionibacterium acnes osteomyelitis of the spine in an adolescent. J Pediatr Orthop B 2003; 12:284.
- Smith EM, Khan MA, Reingold A, Watt JP. Group B streptococcus infections of soft tissue and bone in California adults, 1995-2012. Epidemiol Infect 2015; 143:3343.
- Unkila-Kallio L, Kallio MJ, Eskola J, Peltola H. Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children. Pediatrics 1994; 93:59.
- Ibia EO, Imoisili M, Pikis A. Group A beta-hemolytic streptococcal osteomyelitis in children. Pediatrics 2003; 112:e22.
- Buldu H, Bilen FE, Eralp L, Kocaoglu M. Bilateral Brodie's abscess at the proximal tibia. Singapore Med J 2012; 53:e159.
- Miller WB Jr, Murphy WA, Gilula LA. Brodie abscess: reappraisal. Radiology 1979; 132:15.
- Ogbonna OH, Paul Y, Nabhani H, Medina A. Brodie's Abscess in a Patient Presenting with Sickle Cell Vasoocclusive Crisis. Case Rep Med 2015; 2015:429876.
- Gould CF, Ly JQ, Lattin GE Jr, et al. Bone tumor mimics: avoiding misdiagnosis. Curr Probl Diagn Radiol 2007; 36:124.
- Butt WP. The radiology of infection. Clin Orthop Relat Res 1973; :20.
- Shimose S, Sugita T, Kubo T, et al. Differential diagnosis between osteomyelitis and bone tumors. Acta Radiol 2008; 49:928.
- Seybold U, Talati NJ, Kizilbash Q, et al. Hematogenous osteomyelitis mimicking osteosarcoma due to Community Associated Methicillin-Resistant Staphylococcus aureus. Infection 2007; 35:190.
- Ericsson HM, Sherris JC. Antibiotic sensitivity testing. Report of an international collaborative study. Acta Pathol Microbiol Scand B Microbiol Immunol 1971; 217:Suppl 217:1+.
- Sexton DJ, Heskestad L, Lambeth WR, et al. Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis: report of four cases and review. Clin Infect Dis 1993; 17:695.