Last reviewed: September 2018
Last updated: June  2018

Summary

Definition

History and exam

Key diagnostic factors

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

Other diagnostic factors

  • wound drainage
  • scars, previous flaps
  • reduced range of movement
  • reduced sensation in diabetic foot ulcer
  • urinary tract symptoms
  • torticollis
  • limb deformity
  • tenderness to percussion

Risk factors

  • penetrating injuries
  • surgical contamination
  • intravenous drug misuse
  • diabetes mellitus
  • periodontitis

Diagnostic investigations

1st investigations to order

  • WBC count
  • erythrocyte sedimentation rate (ESR)
  • CRP
  • plain x-rays of affected area
Full details

Investigations to consider

  • ultrasound
  • MRI of bone
  • CT scan
  • radionuclide scans
  • histology
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Senior Clinical Fellow in Limb Reconstruction

The Bone Infection Unit

Nuffield Orthopaedic Centre

Oxford University Hospitals Foundation NHS Trust

Oxford

UK

Disclosures

JF received a research grant in 2013 from Bonesupport AB, Lund, Sweden to collect data for a study on antibiotic carriers in osteomyelitis treatment.

Consultant in Infectious Diseases and Microbiology

Buckinghamshire Healthcare NHS Trust

Aylesbury

UK

Disclosures

THNW declares that he has no competing interests.

Consultant

Infectious Diseases, Microbiology and Bone Infection

Oxford University Hospitals NHS Foundation Trust

Oxford

UK

Disclosures

BLA declares that she has no competing interests.

Consultant in Limb Reconstruction

The Bone Infection Unit

Nuffield Orthopaedic Centre

Oxford University Hospitals Foundation NHS Trust

Oxford

UK

Disclosures

MM received a research grant in 2013 from Bonesupport AB, Lund, Sweden to collect data for a study on antibiotic carriers in osteomyelitis treatment.

Dr Jamie Ferguson, Dr Tse Hua Nicholas Wong, Dr Bridget L. Atkins, and Dr Martin McNally wish to gratefully acknowledge Dr Jason H. Calhoun, Dr Nalini Rao, and Dr M. M. Manring, previous contributors to this topic. JHC, NR, and MMM declare that they have no competing interests.

Peer reviewers VIEW ALL

Assistant Professor

Infectious Diseases

Bayview Medical Center

Baltimore

MD

Disclosures

KJ declares that she has no competing interests.

Associate Professor

Department of Infectious Diseases

University of Naples

Naples

Italy

Disclosures

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.

Professor of Medicine

Infectious Diseases Division

University of Connecticut Health Center

Hartford

CT

Disclosures

EP declares that he has no competing interests.

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