Diagnosis and management of osteomyelitis.

Document Type

Article

Publication Date

11-1-2011

Institution/Department

Family Medicine, Sports Medicine

Journal Title

American family physician

MeSH Headings

Adult, Anti-Bacterial Agents, Child, Debridement, Evidence-Based Medicine, Humans, Medical History Taking, Methicillin-Resistant Staphylococcus aureus, Osteomyelitis, Risk Factors, Staphylococcal Infections, United States

Abstract

The incidence of chronic osteomyelitis is increasing because of the prevalence of predisposing conditions such as diabetes mellitus and peripheral vascular disease. The increased availability of sensitive imaging tests, such as magnetic resonance imaging and bone scintigraphy, has improved diagnostic accuracy and the ability to characterize the infection. Plain radiography is a useful initial investigation to identify alternative diagnoses and potential complications. Direct sampling of the wound for culture and antimicrobial sensitivity is essential to target treatment. The increased incidence of methicillin-resistant Staphylococcus aureus osteomyelitis complicates antibiotic selection. Surgical debridement is usually necessary in chronic cases. The recurrence rate remains high despite surgical intervention and long-term antibiotic therapy. Acute hematogenous osteomyelitis in children typically can be treated with a four-week course of antibiotics. In adults, the duration of antibiotic treatment for chronic osteomyelitis is typically several weeks longer. In both situations, however, empiric antibiotic coverage for S. aureus is indicated.

ISSN

1532-0650

First Page

1027

Last Page

1033

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