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Osteomyelitis

Matthew Mandell, DO and Adam N. Treitman, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • An acute or chronic bone infection with associated inflammation; can occur as a result of hematogenous seeding, contiguous spread of infection, or direct inoculation into intact bone...

DIAGNOSIS

HISTORY

  • Fever, chills, pain, swelling, and erythema, particularly in acute osteomyelitis. These features may be absent in chronic osteomyelitis.

  • Hematogenous osteomyelitis

    • Elicit a history of c...

TREATMENT

GENERAL MEASURES

Adequate nutrition, smoking cessation, glycemic control 

MEDICATION

  • In clinically stable patients, delay initiation of empiric antibiotics until biopsy and/or blood cultures ha...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Blood levels of antimicrobial agents, ESR, CRP, and repeat plain radiography as clinical course dictates. CRP correlates more closely with clini...

REFERENCES

1
Zimmerli W. Clinical practice. Vertebral osteomyelitis. N Engl J Med.  2010;362(11):1022–1029. [View Abstract on OvidMedline]
2
Schmitt SK. Osteomyelitis. Infect Dis Clin North Am. ...

ADDITIONAL READING

  • Malhotra R, Chan CS, Nather A. Osteomyelitis in the diabetic foot. Diabet Foot Ankle.  2014;5. doi:10.3402/dfa.v5.24445. [View Abstract on OvidMedline]

  • Nickerson EK, Sinha R. Ve...

CODES

ICD10

  • M86.9 Osteomyelitis, unspecified

  • M86.00 Acute hematogenous osteomyelitis, unspecified site

  • M86.10 Other acute osteomyelitis, unspecified site

  • M86.8X5 Other osteomyelitis, thigh

  • M86.50 Other chr...

CLINICAL PEARLS

  • Hematogenous osteomyelitis is usually monomicrobial. Osteomyelitis due to contiguous spread or direct inoculation is usually polymicrobial.

  • Pain associated with acute osteomyelitis typi...

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