Haematogenous osteomyelitis

Osteomyelitis is an inflammatory reaction of bone to an infecting organism. It can be classified as exogenous (e.g. from a compound fracture) or haematogenous osteomyelitis (from a bacteraemia). This review focuses on osteomyelitis arising due to a bacteraemia. The differential diagnosis of haematogenous osteomyelitis includes chronic sclerosing osteomyleitis of Garre and chronic recurrent multifocal osteomyelitis. Acute haematogenous osteomyelitis most commonly affects children and infants, although some adults may be predisposed. Classification is based on the route of infection and clinical presentation: acute, subacute or chronic. Organisms preferentially seed into the metaphysis of long bones. Acute infection in bone goes through five pathological phases: inflammation, suppuration, necrosis, new bone formation and resolution. Staphylococcus aureus is the most common infection organism, but other organisms may be responsible and should be sought. The clinical presentation and surgical management are discussed with consideration of the sequellae of acute osteomyelitis (septic arthritis, discitis). Initial treatment is aimed at resuscitation: rehydration, analgesia and splintage of the affected limb. If possible, aspirates should be obtained for culture. Patients should be treated with broad-spectrum antibiotics (i.v.) until an organism can be isolated. The indications for surgical intervention are failure to respond to antibiotics, frank pus on aspiration, intra-articular suppuration or the presence of a sequestered abscess. Tuberculosis infection remains a significant problem worldwide and is included in this contribution.