About osteomyelitis(bone infection)

What is osteomyelitis(bone infection)?

Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs.

Smokers and people with chronic health conditions, such as diabetes or kidney failure, are more at risk of developing osteomyelitis. People who have diabetes may develop osteomyelitis in their feet if they have foot ulcers.

Although once considered incurable, osteomyelitis can now be successfully treated. Most people need surgery to remove areas of the bone that have died. After surgery, strong intravenous antibiotics are typically needed.

What are the symptoms for osteomyelitis(bone infection)?

Sometimes osteomyelitis causes no signs and symptoms or the signs and symptoms are hard to distinguish from other problems. This may be especially true for infants, older adults and people whose immune systems are compromised.

What are the causes for osteomyelitis(bone infection)?

Most cases of osteomyelitis are caused by staphylococcus bacteria, types of germs commonly found on the skin or in the nose of even healthy individuals.

Germs can enter a bone in a variety of ways, including:

  • The bloodstream. Germs in other parts of your body — for example, in the lungs from pneumonia or in the bladder from a urinary tract infection — can travel through your bloodstream to a weakened spot in a bone.
  • Injuries. Severe puncture wounds can carry germs deep inside your body. If such an injury becomes infected, the germs can spread into a nearby bone. Germs can also enter the body if you have broken a bone so severely that part of it is sticking out through your skin.
  • Surgery. Direct contamination with germs can occur during surgeries to replace joints or repair fractures.

What are the treatments for osteomyelitis(bone infection)?

The most common treatments for osteomyelitis are surgery to remove portions of bone that are infected or dead, followed by intravenous antibiotics given in the hospital.

Surgery

Depending on the severity of the infection, osteomyelitis surgery may include one or more of the following procedures:

  • Drain the infected area. Opening up the area around your infected bone allows your surgeon to drain any pus or fluid that has accumulated in response to the infection.
  • Remove diseased bone and tissue. In a procedure called debridement, the surgeon removes as much of the diseased bone as possible and takes a small margin of healthy bone to ensure that all the infected areas have been removed. Surrounding tissue that shows signs of infection also may be removed.
  • Restore blood flow to the bone. Your surgeon may fill any empty space left by the debridement procedure with a piece of bone or other tissue, such as skin or muscle, from another part of your body.

    Sometimes temporary fillers are placed in the pocket until you're healthy enough to undergo a bone graft or tissue graft. The graft helps your body repair damaged blood vessels and form new bone.

  • Remove any foreign objects. In some cases, foreign objects, such as surgical plates or screws placed during a previous surgery, may have to be removed.
  • Amputate the limb. As a last resort, surgeons may amputate the affected limb to stop the infection from spreading further.

Medications

A bone biopsy will reveal what type of germ is causing your infection so your doctor can choose an antibiotic that works well against that type of infection. The antibiotics are usually administered through a vein in your arm for about six weeks. An additional course of oral antibiotics may be needed for more-serious infections.

If you smoke, quitting smoking can help speed healing. It's also important to take steps to manage any chronic conditions you may have, such as keeping your blood sugar controlled if you have diabetes.

What are the risk factors for osteomyelitis(bone infection)?

Your bones are normally resistant to infection, but this protection lessens as you get older. Other factors that can make your bones more vulnerable to osteomyelitis may include:

Recent injury or orthopedic surgery

A severe bone fracture or a deep puncture wound gives bacteria a route to enter your bone or nearby tissue. A deep puncture wound, such as an animal bite or a nail piercing through a shoe, can also provide a pathway for infection.

Surgery to repair broken bones or replace worn joints also can accidentally open a path for germs to enter a bone. Implanted orthopedic hardware is a risk factor for infection.

Circulation disorders

When blood vessels are damaged or blocked, your body has trouble distributing the infection-fighting cells needed to keep a small infection from growing larger. What begins as a small cut can progress to a deep ulcer that may expose deep tissue and bone to infection.

Diseases that impair blood circulation include:

  • Poorly controlled diabetes
  • Peripheral artery disease, often related to smoking
  • Sickle cell disease

Problems requiring intravenous lines or catheters

There are a number of conditions that require the use of medical tubing to connect the outside world with your internal organs. However, this tubing can also serve as a way for germs to get into your body, increasing your risk of an infection in general, which can lead to osteomyelitis.

Examples of when this type of tubing might be used include:

  • Dialysis machine tubing
  • Urinary catheters
  • Long-term intravenous tubing, sometimes called central lines

Conditions that impair the immune system

If your immune system is affected by a medical condition or medication, you have a greater risk of osteomyelitis. Factors that may suppress your immune system include:

  • Cancer treatment
  • Poorly controlled diabetes
  • Needing to take corticosteroids or drugs called tumor necrosis factor inhibitors

Illicit drugs

People who inject illegal drugs are more likely to develop osteomyelitis because they may use nonsterile needles and are less likely to sterilize their skin before injections.

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