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Last reviewed: 25 Jun 2024
Last updated: 21 Mar 2023



History and exam

Key diagnostic factors

  • nonspecific pain at site of infection
  • back pain
  • malaise and fatigue
  • local inflammation, erythema, or swelling
  • low-grade fever
Full details

Other diagnostic factors

  • sinus and/or wound drainage
  • reduced range of movement
  • reduced sensation
  • urinary tract symptoms
  • torticollis
  • limb deformity
  • tenderness to percussion
Full details

Risk factors

  • previous osteomyelitis
  • penetrating injuries
  • surgical contamination
  • distant or local infections
  • intravenous drug misuse
  • diabetes mellitus
  • periodontitis
  • immunocompromise
  • sickle cell anemia
Full details

Diagnostic tests

1st tests to order

  • WBC count
  • erythrocyte sedimentation rate
  • CRP
  • plain x-rays of affected area
  • blood culture
  • MRI of bone
  • guided bone biopsy or open bone biopsy
Full details

Tests to consider

  • ultrasound
  • CT scan
  • radionuclide scans
  • three-phase bone scans
  • histology
Full details

Treatment algorithm


suspected acute peripheral osteomyelitis: low MRSA prevalence

suspected acute peripheral osteomyelitis: high MRSA prevalence

suspected acute native vertebral osteomyelitis

suspected acute osteomyelitis in diabetic foot


confirmed acute peripheral osteomyelitis: adults and children

confirmed acute native vertebral osteomyelitis: adults and children

confirmed acute osteomyelitis in diabetic foot: adults and children


chronic osteomyelitis



Tessa Gomez, MD

Attending, Department of Medicine

Division of Infectious Diseases, Mount Sinai Beth Israel

Assistant Professor, Icahn School of Medicine at Mount Sinai

New York



TG declares that she has no competing interests.


Dr Tessa Gomez would like to gratefully acknowledge Mr Adrian Kendal, Dr Jamie Ferguson, Dr Tse Hua Nicholas Wong, Dr Bridget L. Atkins, Dr Martin McNally, Dr Jason H. Calhoun, Dr Nalini Rao, and Dr M.M. Manring, previous contributors to this topic.


JF received a research grant in 2013 from Bonesupport AB, Lund, Sweden to collect data for a study on antibiotic carriers in osteomyelitis treatment. JF is an author of a number of references cited in this topic. BLA is an author of a number of references cited in this topic. MM is an executive board member of the European Bone & Joint Infection Society and the Girdlestone Orthopaedic Society. He has performed consultancy work for Bonesupport AB and the Oxford Bone Infection Consultancy. He has received travel expenses from Bonesupport AB and the AO Foundation to attend scientific conferences and symposia. He has received royalties from Oxford University Press for contributions to textbooks. MM is an author of a number of references cited in this topic. AK, THNW, JHC, NR, and MMM declare that they have no competing interests.

Peer reviewers

Kristine Johnson, MD

Assistant Professor

Infectious Diseases

Bayview Medical Center




KJ declares that she has no competing interests.

Silvano Esposito, MD

Associate Professor

Department of Infectious Diseases

University of Naples




SE has been reimbursed for attending several conferences and received fees for speaking and running educational programs by Pfizer, Novartis, Wyeth Lederle, Sanofi Aventis, and GSK.

Edward Pesanti, MD

Professor of Medicine

Infectious Diseases Division

University of Connecticut Health Center




EP declares that he has no competing interests.

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