Osteomyelitis (Bone Infection): Symptoms Causes and Treatment

Bone Health osteomyelitis
Medically reviewed by Dr. Mandy Liedeman

Overview of Osteomyelitis

Osteomyelitis is a bone infection that affects different bones in children and adults. Typically, it affects the long bones of the legs in children and the hips, spine, and feet in adults. Discover how to treat this condition, its symptoms, and its causes by reading this article.

What is Osteomyelitis?

Osteomyelitis is a medical ailment in which the bone and adjacent tissue become inflamed and infected. The infection is typically caused by bacteria that penetrate the bone through a wound or spread from another infected area via the bloodstream. It can happen all of a sudden or develop over a long period.

In the general population, the prevalence of Osteomyelitis is estimated to be around 2-5 cases per 10,000 people per year. Also, neglecting the treatment of Osteomyelitis may result in bone damage, abscesses, and sepsis. Therefore, it is essential to consult your doctor promptly.

What are the Types of Osteomyelitis?

Types of Osteomyelitis are the following:

  • Acute Osteomyelitis: It is a form of bone infection that manifests quickly and is commonly triggered by bacteria like Staphylococcus aureus. It typically impacts only one bone and may come with symptoms such as high fever, chills, and intense pain.
  • Chronic Osteomyelitis: It is a severe infection of the bone that doesn’t go away with treatments. It is usually caused by bacteria that have become antibiotic-resistant, and it often involves multiple bones. It causes pain, recurring drainage, and damage to the bones. 

There are also other types of Osteomyelitis that may be classified based on their cause or location, such as:

  • Vertebral Osteomyelitis affects your spine. This condition can cause chronic spinal pain that gets worse whenever you move. It may occur after injury to the spine or post-surgery. Treatments such as resting, heating pads, and pain relievers don’t work. It rarely causes a fever. 
  • Hematogenous Osteomyelitis is a form of Osteomyelitis that results when bacteria from a distant infection disseminate through the bloodstream and infect a bone.
  • Contiguous Osteomyelitis occurs when bacteria from a nearby infection move to a bone, as in the case of open fractures or surgical wounds.
If you Suspect you may have Osteomyelitis, Seek Medical Attention Immediately

Causes of Osteomyelitis

The most common cause of Osteomyelitis is S. aureus bacteria. Other bacteria that can cause Osteomyelitis include Streptococcus, Pseudomonas, and Escherichia coli. You’re more at risk for getting a bone infection if you have the following:

· Hip replacement.

· Blood infections

· Conditions like sickle cell anemia.

· Diabetes-related foot ulcer.

· Metal implants in bone.

· Pressure injuries.

· Bone surgery.

· Traumatic wound.

· Weakened immune system

Risk Factors in Osteomyelitis

Various factors can increase your risk of developing Osteomyelitis. Some of these include:

Illicit drugs

People who inject the intravenous drug are more likely to develop this condition because they may use non-sterile tubes or needles and are less likely to sterilize their skin before injecting.

Recent injury or orthopedic surgery

A significant bone fracture or a deep wound can create a pathway for bacteria to invade the bone or surrounding tissue. Likewise, a deep puncture wound from an animal bite or a sharp object like a tack can also provide an entry point for infection.

Furthermore, surgical procedures to repair fractures or replace worn-out joints can inadvertently create an opening for bacteria to penetrate the bone. Using implanted orthopedic devices is also a risk factor for developing Osteomyelitis.

Compromised immune system

Immune deficiencies are more likely to cause Osteomyelitis. Individuals who have human immunodeficiency virus (HIV), cancer, or those undergoing immunosuppressive therapy, such as after organ transplantation, are particularly vulnerable to developing Osteomyelitis. People with weakened immune systems should take extra care to avoid injuries, practice good hygiene, and seek prompt medical attention if they suspect an infection.


Diabetes increases the risk of developing Osteomyelitis due to poor circulation and nerve damage.

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What are Osteomyelitis Signs and Symptoms?

Usually, the first symptom that occurs is pain at the infected site. Other common Osteomyelitis symptoms may include the following:

  • Fever and chills
  • Redness in the infected or injured site
  • Night sweats
  • Irritability 
  • Feeling tired and unwell
  • Drainage (pus) from the area
  • Swelling in the affected areas
  • Stiffness
  • Inability to use an afflicted limb

It is crucial to understand that the symptoms of Osteomyelitis can overlap with those of other medical conditions. Therefore, an accurate diagnosis requires a comprehensive physical examination and diagnostic imaging tests, such as X-rays, MRI, or CT scans. If you suspect you may be experiencing Osteomyelitis symptoms, seeking immediate medical attention is essential for an accurate diagnosis and timely treatment.

Signs of Complications

Osteomyelitis complications may include the following:

  • Bone death: An infection in your bone can slow down the blood circulation within the bone, leading to permanent bone destruction.
  • Skin cancer: If Osteomyelitis leads to an open sore draining pus, the surrounding skin is more likely to develop squamous cell cancer.
  • Joint damage: Osteomyelitis may cause harm to the joints by spreading to them and damaging their cartilage and other tissues.
  • Septicemia: Osteomyelitis can cause bacteria to enter the bloodstream, leading to a life-threatening condition known as sepsis.

Furthermore, Osteomyelitis commonly develops in three stages, which are as follows:

  1. Acute Osteomyelitis: This stage typically appears within the first two weeks after infection, and it is usually marked by symptoms such as inflammation, fever, and pain.
  2. Subacute Osteomyelitis: It typically occurs within one to several months after infection and is characterized by persistent pain and inflammation.
  3. Chronic Osteomyelitis: This stage develops after several months of infection and is marked by bone destruction, pus formation, and chronic draining wounds.

Osteomyelitis Diagnosis

The osteomyelitis diagnosis typically involves a combination of medical history, physical examination, and diagnostic tests. The following are some common methods used for diagnosing Osteomyelitis:

Diagnostic Tests

Several diagnostic tests may be used to diagnose Osteomyelitis. These tests include:

  • Blood tests: Blood tests identify inflammation and infection in the body. Elevated levels of white blood cells and inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are considered indications of Osteomyelitis.
  • Biopsy: A bone biopsy is a highly accurate diagnostic tool for Osteomyelitis and is often used when the diagnosis is uncertain or when antibiotic treatment is ineffective. It is typically done under local anesthesia using a needle, but in some cases, it may require surgery.
  • Imaging tests: X-rays, CT scans, MRI scans, or bone scans help detect bone infections and abnormalities. X-rays are generally the primary imaging test, but they may only show abnormalities once the condition has advanced. More sensitive techniques like CT scans and MRI scans can identify Osteomyelitis at an earlier stage than X-rays.
Avoid Delaying Treatment for Osteomyelitis, as it can Lead to Further Complications

Treatment Options for Osteomyelitis

Antibiotics are the mainstay of medication treatment for Osteomyelitis. Intravenous antibiotics are usually administered initially to treat acute Osteomyelitis, and the duration of therapy may last for several weeks to several months, depending on the severity of the infection. The Osteomyelitis antibiotics may be administered in a hospital or through a home infusion service. For adults with acute Osteomyelitis, the typical treatment involves using specific antibiotics. Penicillinase-resistant penicillin, ampicillin, or cephalosporin are often prescribed in doses of 8-12 g per day for four to six weeks. Other oral antibiotics, such as clindamycin, rifampin, trimethoprim-sulfamethoxazole, and fluoroquinolones, have also been effective in treating Osteomyelitis. 

Apart from administering antibiotics, Osteomyelitis surgery may be required to remove infected bone or tissue, especially in severe or chronic cases. Surgical interventions may involve debridement, which entails the removal of infected tissue and bone, as well as bone grafting, which entails the replacement of damaged or missing bone with healthy bone from another part of the body or a donor.

To prevent the infection from recurring or developing antibiotic resistance, it is critical to complete the entire course of antibiotics prescribed by a doctor, even if symptoms improve or disappear.

Prevention and Management

Osteomyelitis prevention primarily involves minimizing the risk of infections that can lead to the condition. This includes:

  1. Practicing good hygiene: Good hygiene, such as washing hands regularly, keeping wounds clean and covered, and avoiding contact with potentially contaminated materials, can help prevent infections.
  2. Treating infections promptly: Promptly treating infections, such as skin infections, can help prevent the spread of bacteria to the bones.
  3. Managing chronic conditions: Proper management of chronic conditions, such as diabetes, can help reduce the risk of developing infections that may lead to Osteomyelitis.
  4. Getting vaccinated: Vaccines can help prevent certain infections, such as those caused by pneumococcal bacteria, which can lead to Osteomyelitis.
  5. Proper wound care: Proper wound care includes cleaning and dressing wounds promptly, avoiding unnecessary surgeries, and carefully following the doctor’s instructions after surgery.

In terms of management, it is important to seek prompt medical attention if any signs or symptoms of Osteomyelitis are present, mainly if there is a history of bone infections or recent surgeries. Following the prescribed treatment plan, including taking antibiotics and attending follow-up appointments, is essential to ensure complete recovery and prevent a recurrence. Regular exercise and a balanced diet can strengthen the immune system and prevent infections.

Complications and Prognosis

Osteomyelitis can result in various complications. It can lead to the dissemination of infection to adjacent tissues, such as joints, soft tissues, and the bloodstream, culminating in sepsis, which can be fatal. Chronic pain, joint stiffness, and reduced mobility are other possible complications. If not promptly addressed, Osteomyelitis can progress to bone death or osteonecrosis, which may necessitate amputation of the affected limb.

The prognosis for Osteomyelitis varies depending on several factors. Acute Osteomyelitis can typically be treated successfully with antibiotics, resulting in a good prognosis. However, the prognosis may be less favorable if the infection becomes chronic or the bones are severely damaged.

A range of factors can influence the prognosis of Osteomyelitis. These may encompass the patient’s age, general health status, the extent and duration of the infection, and any underlying medical conditions like HIV or diabetes. Additionally, the effectiveness of antibiotic therapy can play a crucial role in determining the outlook for patients. Individuals with compromised immune systems are particularly vulnerable to Osteomyelitis complications and may experience a less favorable prognosis.

The long-term prospects for Osteomyelitis depend on multiple factors, including the severity of the infection, the success of treatment, and the presence of any associated complications. Adequate and timely treatment can result in full recovery for many patients without lasting problems. However, some individuals may experience enduring Osteomyelitis complications like chronic pain, limited mobility, or bone deformities. Therefore, seeking immediate medical attention and appropriate follow-up care is critical to reducing the risk of such long-term complications.

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Importance of Early Diagnosis and Treatment

The significance of early identification and treatment of Osteomyelitis cannot be emphasized enough. Timely diagnosis and treatment can prevent the spread of infection, decrease the chance of complications, and enhance the outcome. A delay in identifying and treating the condition can cause the infection to spread to nearby tissues and bones, resulting in a challenging treatment process that may necessitate more aggressive management. Furthermore, chronic Osteomyelitis can result in the formation of abscesses and damage to the bones, leading to permanent harm. Managing chronic Osteomyelitis can be difficult, requiring long-term antibiotic therapy and multiple surgeries, which can be physically and emotionally challenging for the patient. Therefore, you must consult the doctor immediately if you experience any signs of Osteomyelitis.

When to Consult a Doctor?

It is essential to consult a doctor if you experience any symptoms of Osteomyelitis, such as persistent bone pain, swelling, redness, fever, and chills that do not improve with rest and over-the-counter pain medications. Additionally, if you have had recent surgery, have an open wound, or have a weakened immune system, you may be at a higher risk for developing Osteomyelitis and should seek medical attention promptly.

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FAQs about Osteomyelitis Answered by Your Doctors Online Team

How to tell if a cut is infected?

If a cut is infected, you may notice increased pain, swelling, redness, warmth around the wound, pus or discharge, and a fever.

What is the strongest antibiotic for cellulitis?

The choice of the most potent antibiotic for cellulitis may differ based on the situation, but vancomycin, daptomycin, or linezolid are frequently prescribed as intravenous (IV) antibiotics for severe cases.

Can Osteomyelitis cause death?

If left untreated or the infection becomes severe, Osteomyelitis can cause death.

Can you fully recover from Osteomyelitis?

Yes, it is possible to fully recover from Osteomyelitis with prompt and appropriate treatment. However, the extent of recovery depends on the severity of the infection and how quickly it is diagnosed and treated.

What bone is the most common site of Osteomyelitis?

Osteomyelitis commonly affects the long bones of arms or legs in children, while in adults, the feet, pelvis, and vertebrae are frequently affected.

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