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Treating Osteomyelitis: Antibiotics and Surgery

Rao, Nalini M.D.; Ziran, Bruce H. M.D.; Lipsky, Benjamin A. M.D.

Plastic & Reconstructive Surgery: January 2011 - Volume 127 - Issue - pp 177S-187S
doi: 10.1097/PRS.0b013e3182001f0f
Wound-Healing Supplement: Original Articles

Background: Osteomyelitis is an inflammatory disorder of bone caused by infection leading to necrosis and destruction. It can affect all ages and involve any bone. Osteomyelitis may become chronic and cause persistent morbidity. Despite new imaging techniques, diagnosis can be difficult and often delayed. Because infection can recur years after apparent “cure,” “remission” is a more appropriate term.

Methods: The study is a nonsystematic review of literature.

Results: Osteomyelitis usually requires some antibiotic treatment, usually administered systemically but sometimes supplemented by antibiotic-containing beads or cement. Acute hematogenous osteomyelitis can be treated with antibiotics alone. Chronic osteomyelitis, often accompanied by necrotic bone, usually requires surgical therapy. Unfortunately, evidence for optimal treatment regimens or therapy durations largely based upon expert opinion, case series, and animal models. Antimicrobial therapy is now complicated by the increasing prevalence of antibiotic-resistant organisms, especially methicillin-resistant Staphylococcus aureus. Without surgical resection of infected bone, antibiotic treatment must be prolonged (≥4 to 6 weeks). Advances in surgical technique have increased the potential for bone (and often limb) salvage and infection remission.

Conclusions: Osteomyelitis is best managed by a multidisciplinary team. It requires accurate diagnosis and optimization of host defenses, appropriate anti-infective therapy, and often bone débridement and reconstructive surgery. The antibiotic regimen must target the likely (or optimally proven) causative pathogen, with few adverse effects and reasonable costs. The authors offer practical guidance to the medical and surgical aspects of treating osteomyelitis.

Pittsburgh, Pa.; Atlanta, Ga.; and Seattle, Wash.

From the University of Pittsburgh School of Medicine, Atlanta Medical Center, and Veterans Affairs Puget Sound Health Care System, University of Washington.

Received for publication May 28, 2010; accepted September 7, 2010.

Disclosure: Dr. Lipsky has been a consultant to and received research funding from Pfizer, Ortho-McNeil/Johnson & Johnson, Cubist, and Merck. The other authors have no financial interest to disclose.

Nalini Rao, M.D.; 5750 Centre Avenue, Suite 510; Pittsburgh, Pa. 15206; raon@upmc.edu

©2011American Society of Plastic Surgeons