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Upon completion of the chapter, the reader will be able to:

  1. List common risk factors for osteomyelitis.

  2. Discuss the pathophysiology of osteomyelitis.

  3. Compare and contrast the classic signs and symptoms of acute and chronic osteomyelitis.

  4. Evaluate microbiology culture data and other laboratory tests utilized for the diagnosis and treatment of bone infections.

  5. List the most common pathogens isolated in acute and chronic osteomyelitis.

  6. Develop a treatment plan for osteomyelitis.

  7. Recommend parameters to monitor antimicrobial therapy for effectiveness and toxicity.

  8. Educate patients regarding disease state and drug therapy.




  • Image not available. Osteomyelitis, an infection of the bone, can be an acute or chronic process.

  • Image not available. Osteomyelitis is most often classified by duration of disease and route of infection.

  • Image not available. Staphylococcus aureus is the predominant pathogen seen in all types of osteomyelitis, with methicillin-resistant S. aureus (MRSA) being increasingly reported. However, the spectrum of potential causative pathogens varies with patient-specific risk factors and route of infection.

  • Image not available. The gold standard for diagnosis of osteomyelitis is a bone biopsy with isolation of microorganism(s) from culture and the presence of inflammatory cells and osteonecrosis on histologic exam. Due to the invasive nature of the bone biopsy, the diagnosis of osteomyelitis is often based on clinical findings, laboratory tests, and imaging studies rather than bone biopsy.

  • Image not available. Typical signs and symptoms of osteomyelitis include local pain and tenderness over the affected bone, as well as inflammation, erythema, edema, and decreased range of motion. Patients with acute hematogenous osteomyelitis may also present with fever, chills, and malaise.

  • Image not available. The treatment goals for acute and chronic osteomyelitis are to eradicate the infection and prevent recurrence. Higher cure rates are seen with acute compared with chronic osteomyelitis. Therefore, in chronic osteomyelitis, a common treatment goal for many patients is to prevent complications such as amputation.

  • Image not available. Treatment of osteomyelitis is dependent on the extent of bone necrosis. For acute osteomyelitis with minimal bone destruction, an extended course of antimicrobial therapy should effectively treat the infection; however, in chronic osteomyelitis, surgical intervention is also typically required.

  • Image not available. Empiric antimicrobial therapy should target likely causative pathogen(s) based on patient-specific risk factors and route of infection. With the increased incidence of MRSA, the use of anti-MRSA antimicrobials should be considered as first-line therapy for empiric coverage of suspected staphylococcal osteomyelitis. However, therapy should be modified based on culture and sensitivity data.

  • Image not available. The duration of antimicrobial therapy is usually 4 to 8 weeks.

  • Image not available. Patients should be monitored for clinical and laboratory response, development of adverse drug reactions, and potential drug–drug interactions. Patients should also be closely monitored for adherence in the outpatient setting.




Image not available. Osteomyelitis is an infection of the bone that is associated with high morbidity and increased healthcare costs. The inflammatory response associated with acute osteomyelitis can lead to bone necrosis and subsequently chronic infections. Bacterial pathogens, particularly Staphylococcus aureus, are the most common microorganisms implicated in these infections. Diagnosis ...

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