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Nonvertebral osteomyelitis

Background

Overview

Definition
Nonvertebral osteomyelitis is an infection that affects the bone tissue outside of the vertebral column.
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Pathophysiology
The pathophysiology of osteomyelitis involves the invasion of microorganisms into the bone, leading to inflammation and bone destruction. Bacteria can reach the bone through the bloodstream or from nearby tissue. In some cases, bacteria can invade the bone directly due to an open fracture or surgery.
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Epidemiology
The incidence of osteomyelitis in the US is estimated at 21.8 per 100,000 person-years.
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Risk factors
Risk factors for osteomyelitis include conditions that compromise the immune system or blood flow to the bone, such as diabetes, PAD, and recent trauma or surgery. Invasive medical procedures, such as joint replacements or bone surgeries, can also increase the risk of osteomyelitis.
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Disease course
Clinically, osteomyelitis often presents with symptoms such as bone pain, swelling, redness, and fever. In some cases, patients may also experience reduced ROM. Chronic osteomyelitis can lead to the formation of sinus tracts, draining pus to the skin.
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Prognosis and risk of recurrence
The prognosis of osteomyelitis depends on the promptness of diagnosis and appropriateness of treatment. If left untreated, osteomyelitis can lead to serious complications, including abscess formation, sepsis, and chronic osteomyelitis.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of nonvertebral osteomyelitis are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA/IWGDF 2024), the American College of Radiology (ACR 2022), the American Academy of Family Physicians (AAFP 2021), the Infectious Diseases Society of America (IDSA/PIDS 2021), the Infectious Diseases Society of America (IDSA ...
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Screening and diagnosis

Diagnosis: as per AAFP 2021 guidelines, diagnose osteomyelitis based on a positive bacterial culture from bone biopsy, while using clinical, laboratory, and radiographic findings to inform a clinical diagnosis.
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Diagnostic investigations

Diagnostic imaging
As per ACR 2022 guidelines:
Obtain radiography area of interest as initial imaging in patients with suspected osteomyelitis.
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Obtain MRI area of interest in patients with suspected osteomyelitis following normal radiographs or with findings suggestive of osteomyelitis, including in the setting of extra-articular surgical hardware.
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Specific circumstances

Pediatric patients, evaluation: as per IDSA/PIDS 2021 guidelines, consider obtaining serum CRP in the initial evaluation of patients with suspected acute hematogenous osteomyelitis.
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More topics in this section

  • Pediatric patients (management)

  • Pediatric patients (follow-up)

  • Patients with diabetic foot osteomyelitis (physical examination)

  • Patients with diabetic foot osteomyelitis (inflammatory markers)

  • Patients with diabetic foot osteomyelitis (radiography)

  • Patients with diabetic foot osteomyelitis (MRI)

  • Patients with diabetic foot osteomyelitis (tagged WBC and bone scans)

  • Patients with diabetic foot osteomyelitis (other imaging modalities)

  • Patients with diabetic foot osteomyelitis (bone culture and histology)

  • Patients with diabetic foot osteomyelitis (general principles of management)

  • Patients with diabetic foot osteomyelitis (empiric antibiotic therapy)

  • Patients with diabetic foot osteomyelitis (duration of antibiotic therapy)

  • Patients with diabetic foot osteomyelitis (surgical interventions)

  • Patients with diabetic foot osteomyelitis (topical antimicrobials)

  • Patients with chronic osteomyelitis

  • Patients with MRSA osteomyelitis (evaluation)

  • Patients with MRSA osteomyelitis (management)

  • Patients with Candida osteomyelitis

  • Patients with Aspergillus osteomyelitis