Osteomyelitis

Overview

Osteomyelitis is an infection in a bone. It can affect one or more parts of a bone. Infections can reach a bone through the bloodstream or from nearby infected tissue. Infections also can begin in the bone if an injury opens the bone to germs.

People who smoke and people with chronic health conditions, such as diabetes or kidney failure, are at higher risk of getting osteomyelitis. People who have diabetes with foot ulcers may get osteomyelitis in the bones of their feet.

Most people with osteomyelitis need surgery to remove areas of the affected bone. After surgery, most often people need strong antibiotics given through a vein.

Symptoms

Symptoms of osteomyelitis may include:

• Swelling, warmth and tenderness over the area of the infection.
• Pain near the infection.
• Tiredness.
• Fever.

Sometimes osteomyelitis causes no symptoms. When it does cause symptoms, they can be like symptoms of other conditions. This may be especially true for infants, older adults and people who have weakened immune systems.

When to see a doctor

See your healthcare professional if you have a fever and bone pain that gets worse. People at risk of infection because of a medical condition or recent surgery or an injury should see a healthcare professional right away if they have symptoms of an infection.

Causes

Most often, staphylococcus bacteria cause osteomyelitis. These bacteria are germs that live on the skin or in the nose of all people.

Germs can enter a bone through:

• The bloodstream. Germs in other parts of your body can travel through the blood to a weak spot on a bone. For instance, germs can come from pneumonia in the lungs or a urinary tract infection in the bladder.
• Injuries. Puncture wounds can carry germs deep inside the body. If such an injury becomes infected, the germs can spread into a nearby bone. Germs also can enter the body from a broken bone that sticks out through the skin.
• Surgery. Germs can enter the body and travel to bones during surgeries to replace joints or fix broken bones.

Risk factors

Healthy bones resist infection. But bones are less able to resist infection as you get older. Besides wounds and surgery, other factors that can increase your risk of osteomyelitis may include:

• Conditions that weaken the immune system. This includes diabetes that isn't well-controlled.
• Peripheral artery disease. This is a condition in which narrowed arteries cut blood flow to the arms or legs.
• Sickle cell disease. This condition is passed through families, called inherited. Sickle cell disease affects the shape of red blood cells and slows blood flow.
• Dialysis and other procedures that use medical tubing. Dialysis uses tubes to remove waste from the body when the kidneys don't work well. The medical tubes can carry germs from outside the body inside.
• Pressure injuries. People who can't feel pressure or who stay in one position for too long can get sores on their skin where the pressure is. These sores are called pressure injuries. If a sore is there for a time, the bone under it can become infected.
• Illicit drugs by needles. People who take illicit drugs by needle are more likely to get osteomyelitis. This is true if they use needles that aren't sterile and if they don't clean the skin before using the needles.

Complications

Osteomyelitis complications may include:

• Bone death, also called osteonecrosis. An infection in your bone can block blood flow within the bone, leading to bone death. If you have areas where bone has died, you need surgery to remove the dead tissue for antibiotics to work.
• Septic arthritis. Infection within bones can spread into a nearby joint.
• Impaired growth. Osteomyelitis can affect the growth of bones in children. This is true if osteomyelitis is in the softer areas, called growth plates, at either end of the long bones of the arms and legs.
• Long-term osteomyelitis, called chronic osteomyelitis. Osteomyelitis that doesn't respond to treatment can become chronic osteomyelitis.

Prevention

If you have an increased risk of infection, talk with your healthcare professional about ways to prevent infections. Cutting your risk of infection will cut your risk of osteomyelitis.

Take care not to get cuts, scrapes, and animal scratches or bites. These give germs a way to get into your body. If you or your child has a minor injury, clean the area right away. Put a clean bandage on it. Check wounds often for signs of infection.