Who treats osteomyelitis?

Management of Osteomyelitis: A Multidisciplinary Approach

Osteomyelitis is optimally treated by a multidisciplinary team including orthopedic surgeons, infectious disease specialists, and interventional radiologists to reduce morbidity, mortality, and preserve quality of life. 1

Key Healthcare Professionals Involved in Osteomyelitis Management

• Orthopedic surgeons are essential for performing surgical debridement, bone resection, and reconstruction procedures that are often necessary for definitive treatment of osteomyelitis 2
• Infectious disease specialists guide appropriate antibiotic selection and duration based on culture results and patient factors 1
• Interventional radiologists perform image-guided bone biopsies when needed for definitive diagnosis 2
• Podiatrists may perform bone biopsies and surgical procedures, particularly for diabetic foot osteomyelitis 2
• Plastic surgeons provide expertise for soft tissue coverage and muscle flap procedures when needed for complex cases 3

Diagnostic Approach

• Bone biopsy is the gold standard for diagnosis and should be performed by a properly trained physician (orthopedic surgeon, podiatrist, or interventional radiologist) 2
• Percutaneous biopsy should preferably be done under fluoroscopic or CT guidance 2
• MRI is the most accurate imaging study for defining bone infection and should be ordered when diagnosis remains uncertain 2
• Cultures of bone specimens provide more accurate microbiologic data than soft tissue specimens 2

Treatment Algorithm

1. Initial Assessment

• Determine extent of infection through appropriate imaging 2
• Obtain bone cultures to guide antibiotic therapy 2

2. Surgical Management

• Surgical intervention should be strongly considered in cases with:
  • Substantial bone necrosis or exposed joint 1
  • Functionally compromised foot 1
  • Presence of resistant pathogens 1
  • Limb with uncorrectable ischemia 1

3. Antibiotic Therapy

• Base selection on bone culture results rather than soft tissue cultures 1
• Initial parenteral therapy followed by oral antibiotics with good bioavailability 2
• Duration depends on surgical approach:
  • 2-14 days if infected bone is completely removed 1
  • 4-6 weeks for non-surgical management 1

Special Considerations for Non-Surgical Management

Non-surgical management with antibiotics alone might be considered in specific situations:

• No acceptable surgical target (radical cure would cause unacceptable functional loss) 2
• Patient has limb ischemia caused by unreconstructable vascular disease 2
• Infection confined to forefoot with minimal soft tissue loss 2
• Surgical management carries excessive risk 2

Common Pitfalls to Avoid

• Relying on soft tissue cultures rather than bone cultures to guide antibiotic therapy 1
• Continuing the same antibiotic regimen that previously failed 1
• Inadequate surgical debridement of necrotic bone 1
• Not addressing vascular insufficiency which limits antibiotic delivery 1

Treatment Outcomes

• Successful management of osteomyelitis requires thorough debridement of infected bone and soft tissues coupled with appropriate antibiotics 3
• Published reports on nonsurgical treatment with prolonged antibiotics have reported clinical success in approximately 65%-80% of cases 2
• Operated patients have significantly fewer relapses compared to those treated with antibiotics alone 4

When Treatment Fails

When therapy fails, consider:

• Whether the original diagnosis was correct 2
• If there is residual necrotic or infected bone that should be resected 2
• If the selected antibiotic regimen covered the causative organisms and achieved adequate bone levels 2
• Whether non-infectious complications are the real cause of the problem 2