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Hematogenous osteomyelitis in adults

Jason Calhoun, MD
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 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).

The site of infection varies with age. In children, the most common sites of involvement are the long bones (eg, femur, tibia, and humerus); vertebral osteomyelitis accounts for only 1 to 2 percent of cases [5]. In adults, the long bones are rarely involved; the major sites of infection are the vertebrae and the sternoclavicular and pelvic bones (the latter two most commonly occurring in intravenous drug users) [6]. (See "Pelvic osteomyelitis and other infections of the bony pelvis in adults".)


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Literature review current through: Sep 2016. | This topic last updated: Jan 21, 2015.
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