Osteomyelitis is an acute or chronic inflammation of the bone due to an infection resulting from hematogenous spread, contiguous spread from soft tissues and joints to bone, or direct inoculation into bone from surgery or trauma.
The infection is generally due to a single microorganism but polymicrobial infections may also occur.
Staphylococcus aureus is a major cause of infection.
Signs and symptoms include fever; inflammatory findings of erythema, warmth, pain and swelling over the involved area; draining sinus tracts over affected bone; limited movement of affected extremity; pain in the chest, back, abdomen or leg, and tenderness over involved vertebrae in patients with vertebral osteomyelitis; anorexia, vomiting and malaise.

Follow Up

  • Response to treatment is evaluated through clinical (ie symptom resolution) & lab parameters
    • Erythrocyte sedimentation rate (ESR) levels usually reach peak levels 3-5 days after the start of treatment & return to normal in about 2 wk
    • C-reactive protein (CRP) levels peak 2 days after the start of treatment & return to normal after about 1 wk
  • Antibiotic therapy should be revised based on results of culture & sensitivity studies
  • If cultures are sterile & symptoms are resolving, empiric antibiotic therapy should be continued
  • Assess patient’s need to be enrolled in a community-based parenteral anti-infective therapy program
    • A functioning outpatient parenteral antimicrobial therapy (OPAT) program should have a complete & qualified health care team, efficient means of communication, guidelines for follow-up, testing & other interventions, written policies & procedures & outcomes monitoring
    • A candidate for inclusion in an outpatient parenteral antimicrobial therapy (OPAT) program should be willing to participate in the program & should have a home environment that is sufficient to support care
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