Osteomyelitis is an infection of bone, most often caused by Staphylococcus aureus. It can spread through the blood, as in children, or from a nearby wound or diabetic foot ulcer, and it needs long courses of antibiotics.
Key symptoms
- Bone pain and tenderness
- Fever and chills, mostly in acute infection
- Children refusing to walk or use a limb
- Draining wound or ulcer that does not heal
What you find on exam
- Warmth, swelling and redness over the bone
- Positive probe-to-bone test in a diabetic foot ulcer
- Sinus tract with drainage
- Foot pulses and sensation
Tests
- ESR and CRP (high), blood count, blood cultures
- MRI: the best imaging test
- X-ray: changes appear only after about 2 weeks
- Bone biopsy with culture to guide antibiotics
Treatment basics
- IV antibiotics such as vancomycin plus a beta-lactam such as cefepime until cultures return
- Targeted antibiotics for 4 to 6 weeks
- Surgical debridement of dead bone
- Blood sugar control and better blood flow in the diabetic foot
Red flags
- Sepsis: fever with low blood pressure
- Back pain with fever or neurologic deficits (vertebral osteomyelitis)
- Exposed bone in a diabetic ulcer
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.