Overview of osteomyelitis in adults
- Tahaniyat Lalani, MBBS, MHS
Tahaniyat Lalani, MBBS, MHS
- Associate Professor
- Uniformed Services University of the Health Sciences
Osteomyelitis is infection localized to bone . An overview of the pathophysiology, classification, microbiology, clinical manifestations, diagnosis, and treatment of osteomyelitis is presented here. Issues related to diabetic foot infections, as well as osteomyelitis in the setting of trauma, vertebral osteomyelitis, and hematogenous osteomyelitis, are reviewed in detail separately. (See "Clinical manifestations, diagnosis, and management of diabetic infections of the lower extremities" and "Treatment and prevention of osteomyelitis following trauma in adults" and "Vertebral osteomyelitis and discitis in adults" and "Hematogenous osteomyelitis in adults".)
Osteomyelitis is one of the oldest recorded diseases, with descriptions dating back to the time of Hippocrates (460 to 370 BC) . Terms such as "abscessus in medulla," "necrosis," and "a boil of the bone marrow" were used to describe the infection until Nelaton introduced the term "osteomyelitis" in 1844.
Prior to the introduction of penicillin in 1940, the management of acute osteomyelitis was purely surgical, with large incisions for removal of all necrotic bone . Wounds were packed with Vaseline gauze and left to heal by secondary intention after immobilization. Mortality rates remained high (about 33 percent) due to sepsis until the introduction of penicillin, which dramatically changed the treatment and prognosis of osteomyelitis. Complications such as sequestration, sinus formation, and sepsis became less common, and the goals of therapy changed from disease containment to cure.
Hematogenous osteomyelitis occurs more commonly in children than adults; in children, long bones are most often affected, while in adults the vertebrae are the most common site . Contiguous osteomyelitis tends to occur in younger individuals in the setting of trauma and related surgery, and, in older adults, secondary to decubitus ulcers and infected total joint arthroplasties . Osteomyelitis associated with vascular insufficiency is usually seen in individuals with diabetes mellitus.
Osteomyelitis can occur as a result of hematogenous seeding, contiguous spread of infection to bone from adjacent soft tissues and joints, or direct inoculation of infection into the bone as a result of trauma or surgery. Hematogenous osteomyelitis is usually monomicrobial, while osteomyelitis due to contiguous spread or direct inoculation is usually polymicrobial.
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- CLINICAL MANIFESTATIONS
- Probing to bone
- Laboratory tests
- Clinical approach
- Bone biopsy
- - Cultures
- - Histopathology
- DIFFERENTIAL DIAGNOSIS
- Antibiotic selection
- Duration of therapy
- Adjunctive therapies
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS