Osteomyelitis is a bone infection caused by bacteria or other germs.
Bone infection is most often caused by bacteria. But it can also be caused by fungi or other germs. When a person has osteomyelitis:
- Bacteria may spread to a bone from infected skin, muscles, or tendons next to the bone. This may occur under a skin sore.
- The infection can start in another part of the body and spread to the bone through the blood.
- The infection can also start after bone surgery. This is more likely if the surgery is done after an injury or if metal rods or plates are placed in the bone.
In children, the long bones of the arms or legs are most often involved. In adults, the feet, spine bones (vertebrae), and hips (pelvis) are most commonly affected.
Risk factors are:
People who have had their spleen removed are also at high risk of osteomyelitis.
- Bone pain
- Excessive sweating
- Fever and chills
- General discomfort, uneasiness, or ill-feeling (malaise)
- Local swelling, redness, and warmth
- Pain at the site of infection
- Swelling of the ankles, feet, and legs
Exams and Tests
A physical exam shows bone tenderness and possibly swelling and redness.
Tests may include:
- Blood cultures
- Bone biopsy (the sample is cultured and examined under a microscope)
- Bone scan
- Bone x-ray
- Complete blood count (CBC)
- C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR)
- MRI of the bone
- Needle aspiration of the area of the affected bones
The goal of treatment is to get rid of the infection and reduce damage to the bone and surrounding tissues.
Antibiotics are given to destroy the bacteria causing the infection:
- You may receive more than one antibiotic at a time.
- Antibiotics are taken for at least 4 to 6 weeks, often at home through an IV (intravenously, meaning through a vein).
Surgery may be needed to remove dead bone tissue if you have an infection that does not go away:
- If there are metal plates near the infection, they may need to be removed.
- The open space left by the removed bone tissue may be filled with bone graft or packing material. This promotes the growth of new bone tissue.
Infection that occurs after joint replacement may need surgery to remove the replaced joint and infected tissue around the area. A new prosthesis may be implanted in the same operation. More often, doctors wait until the infection has gone away.
If you have diabetes, it will need to be well controlled. If there are problems with blood supply to the infected area, such as the foot, surgery to improve blood flow may be needed to get rid of the infection.
With treatment, the outcome for acute osteomyelitis is usually good.
Outlook is worse for those with long-term (chronic) osteomyelitis. Symptoms may come and go for years, even with surgery. Amputation may be needed, especially in persons with diabetes or poor blood circulation.
Outlook for persons with an infection of the prosthesis depends, in part, on:
- The patient's health
- The type of infection
- Whether the infected prosthesis can be safely removed
When to Contact a Medical Professional
Call your health care provider if:
- You develop symptoms of osteomyelitis
- You have osteomyelitis and the symptoms continue despite treatment
Matteson EL, Osmon DR. Infections of bursae, joints, and bones. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 280.
Dabov GD. Osteomyelitis. In: Canale ST, Beaty JH, eds. Campbell’s Operative Orthopaedics. Philadelphia, Pa: Elsevier Mosby; 2012:chap 21.
Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.