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  • image The most common cause of osteomyelitis (particularly that acquired by hematogenous spread) and infectious arthritis is Staphylococcus aureus.
  • image Culture and susceptibility information are essential as a guide for antimicrobial treatment of osteomyelitis and infectious arthritis.
  • image Joint aspiration and examination of synovial fluid are extremely important to evaluate the possibility of infectious arthritis.
  • image The most important treatment modality of acute osteomyelitis is the administration of appropriate antibiotics in adequate doses for a sufficient length of time.
  • image Antibiotics generally are given in high doses so that adequate antimicrobial concentrations are reached within infected bone and joints.
  • image The standard duration of antimicrobial treatment for acute osteomyelitis is 4 to 6 weeks.
  • image Oral antimicrobial therapies can be used for osteomyelitis to complete a parenteral regimen in children who have had a good clinical response to IV antibiotics and in adults without diabetes mellitus or peripheral vascular disease when the organism is susceptible to the oral antimicrobial, a suitable oral agent is available, and compliance is ensured.
  • image The three most important therapeutic approaches to the management of infectious arthritis are appropriate antibiotics, joint drainage, and joint rest.
  • image Monitoring of antibiotic therapy is important and typically involves noting clinical signs of inflammation, periodic white blood cell (WBC) counts, C-reactive protein, erythrocyte sedimentation rate (ESR) determinations, and radiographic findings.

On completion of the chapter, the reader will be able to:

  1. Compare the epidemiology of osteomyelitis when categorized by the mechanism of the organism reaching the bone.

  2. Differentiate the characteristics of infectious arthritis.

  3. Contrast the most common characteristics of hematogenous osteomyelitis.

  4. Compare the pathophysiology of osteomyelitis by age group.

  5. Select the most frequent organisms causing hematogenous osteomyelitis.

  6. Contrast the most common characteristics of contiguous-spread osteomyelitis.

  7. Discuss the organism sources of infectious arthritis.

  8. Differentiate the risk factors for developing adult infectious arthritis.

  9. Compare the etiologies of adult infectious arthritis subgroups.

  10. Design a laboratory monitoring strategy for bone and joint infections.

  11. Contrast the usefulness of culture sites with bone and joint infections.

  12. Choose the preferred duration of therapy for patients with bone and joint infections.

  13. Discuss the patient selection characteristics for oral antibiotic regimens treating osteomyelitis.

  14. Critique the use of oral fluoroquinolones in the treatment of bone and joint infections.

  15. Construct an empiric antibiotic regimen for different patient categories with bone or joint infections.

Bone and joint infections are comprised of two disease processes known, respectively, as osteomyelitis and septic or infectious arthritis. They are unique and separate infectious entities with different signs and symptoms and infecting organisms. Despite advances in therapy, these infections continue to cause significant morbidity from residual damage and chronic or recurring infections. Emphasis on initiating antibiotic therapy as soon as possible is important in reducing long-term complications.

Osteomyelitis generally is an uncommon disease. One classic publication reported that 247 patients had osteomyelitis in a prominent American teaching hospital during a 4-year period.1 Acute osteomyelitis has an estimated annual incidence of 0.4 per 1,000 children.2 In adults, osteomyelitis ...

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