An Overview of Osteomyelitis

Osteomyelitis is an infection involving bone. Most cases are caused by bacteria called Staphylococcus aureus. Certain diseases, such as diabetes, sickle cell disease, human immunodeficiency virus (HIV), rheumatoid arthritis and being on dialysis appear to increase a person's risk for osteomyelitis. Intravenous (IV) drug use is also a risk factor. might increase a person’s risk for osteomyelitis. Affecting 2 out of every 10,000 people, both children and adults, osteomyelitis may cause pain and swelling in affected areas, fever, and drainage, in addition to other symptoms.

If left untreated, this condition may become chronic and cause blood supply loss—this may eventually lead to the death of bone tissues.

Symptoms

Since osteomyelitis is an infection, possible symptoms are similar to what you would see with other types of infections, including:

• Localized pain
• Fever and chills
• Redness and swelling in the affected area
• A general feeling of sickness
• Lack of energy or fatigue
• Irritability
• Drainage or pus
• Stiffness and inability to move the affected limb

Causes

Osteomyelitis can occur through by spreading through the bloodstream (hematogenous spread) or from local contiguous spread to the bone; for example, from a fracture, a prosthetic joint or other orthopedic hardware, a local wound, ulcer, or cellulitis. The incidence of osteomyelitis is increasing in the United States. Children are more likely to have long bones affected whereas the spine is more commonly affected in adults.

Osteomyelitis is considered acute if it is diagnosed within two weeks, and chronic if it has been present for longer periods. The chronic form is less likely to have systemic symptoms such as fever and elevated white blood cell count, and blood cultures are less likely to be positive. Blood cultures are more likely to be positive with hematogenous spread.

Chronic osteomyelitis can destroy the bone, can sometimes spread to the bloodstream and may increase mortality risk.

People at risk for osteomyelitis are those who have:

• Skin infections
• Open wounds near a broken bone that breaks into skin
• Puncture wounds through the skin
• Recently had surgery
• Diabetes
• Poor blood circulation

Some diseases that increase your risk may include those that lower the body’s ability to fight infections, including autoimmune diseases. Smoking may also increase a person’s risk for osteomyelitis.

Diagnosis

Tests to diagnose osteomyelitis include blood tests, wound cultures, bone scans, and X-rays. Blood work will show signs of infection. Samples of drainage from the wound or affected bone may help determine the type of bacteria causing the infection. Because superficial drainage may be contaminated with bacteria not responsible for the bone infection, an actual biopsy of the infected bone is one of the more definitive ways to determine the causative organism (which will then guide antibiotic choice).

Plain X-rays and bone scans may also show signs of infection and reveal any damage to bones. If plain X-rays are non-revealing, magnetic resonance imaging (MRI) is the preferred next test, although computed tomography (CT) scans may also be ordered. Once diagnosed, treatment can begin.

Treatment

The infection is usually treated with antibiotics over a period of four to six weeks, although longer courses may be needed in chronic infections and with certain organisms. Most of the time, antibiotics are given by IV (intravenously, meaning through a vein). After some time, antibiotic treatment is switched to pills or liquid. Chronic osteomyelitis may require surgery to remove any dead tissue or dead pieces of bone from the infected area. In some cases, bone may need to be surgically repaired.

When chronic osteomyelitis is not responding to treatments or affects the spine, skull, or chest, hyperbaric oxygen treatment (HBOT) is considered. HBOT treatment involves putting the patient in a chamber that increases pressure throughout the body and allows the lungs to absorb pure oxygen. More oxygen in the blood and tissues will help the body to fight infection and heal quicker.

Research shows HBOT is safe and effective for managing chronic osteomyelitis. Rare complications of HBOT include eye, ear, tooth, sinus, or lung injury. It may lower the blood sugar and might cause a seizure, especially in someone who has a known seizure disorder.

Complications

If left untreated or in very serious cases, osteomyelitis can lead to osteonecrosis (bone death). This usually happens when the infection impedes blood flow to the bone. Septic arthritis is another consequence of osteomyelitis causing infection to spread to nearby joints.

Open sores from osteomyelitis that need to be drained may increase the risk for a type of skin cancer called squamous cell cancer. This type of skin cancer affects more than one million people in the United States yearly and forms in the middle and outer layers of the skin.

Prevention

Prevention of osteomyelitis is possible and starts by avoiding wound and skin infections. Skin wounds should be cleaned well and covered with a clean and sterile bandage. If there are signs of infection, see your healthcare provider as soon as possible. Immediate medical attention for deep wounds and bone injuries is vital.

People who have diseases that make it harder for them to fight off infection should talk to their practitioners about the best ways to reduce their infection risk.

A Word From Verywell

The outcome for people with acute osteomyelitis who receive prompt treatment is a positive one. People with chronic osteomyelitis may have worse outcomes if the condition is left untreated or worsens without appropriate treatment. It is a good idea to contact your healthcare provider if you think you have symptoms of osteomyelitis or if you have been diagnosed and your symptoms continue despite treatment. People with weakened immune systems should work with their practitioners to find the best ways to prevent the risk of infection.