Osteomyelitis

Osteomyelitis is an infection of the bone. Any bone can be affected, but it is most common in arm and leg bones in children, and in the foot, back and pelvis bones in adults. Early treatment reduces the chance of permanent bone damage.

Without treatment, osteomyelitis can lead to blood poisoning (sepsis) or an abscess in the bone. This in turn can lead to loss of a limb or death.

If you have osteomyelitis, you may experience:

• fever
• pain and stiffness in the bone
• swelling, redness and warmth in the affected area
• fatigue
• feeling generally unwell

Osteomyelitis is most commonly caused by Staphylococcus aureus, a type of bacteria found on the skin, also known as 'staph'. The bone may become infected after an injury, such as a bone fracture, or surgery. These events may allow bacteria from the skin to enter the body and infect the bones.

Osteomyelitis can also happen when there is an infection in another part of the body that spreads through the blood to the bone. A urinary tract infection or pneumonia are examples of such infections.

If osteomyelitis is first diagnosed within the first14 days of symptoms, it is called acute osteomyelitis. If the bone infection continues or keeps coming back, it is called chronic osteomyelitis.

Osteomyelitis is more common in people with immune system problems or have a chronic disease such as:

• diabetes
• HIV
• rheumatoid arthritis
• sickle cell anaemia
• kidney disease needing dialysis

See your doctor if you are concerned that you may have osteomyelitis. This might be because you have skin changes (swelling, redness and warmth), bone pain, or fever that lasts for longer than a few days without a clear cause.

When should my child see the doctor?

If you think your child might have osteomyelitis, see a doctor immediately. Osteomyelitis can present differently in children than in adults. If they have osteomyelitis your child might:

• have a fever
• have a limp or refuse to put weight on a particular limb
• have a sore arm or leg
• feel generally unwell

When should I seek urgent care?

If you have symptoms of osteomyelitis, you should seek urgent care. Early intervention is important to promote healing and prevent complications.

When should I go to the emergency department?

You should go to the emergency department if you have:

• a fever over 39°C with severe bone pain
• severe bone pain near a recent wound, especially if there is pus or discharge
• quickly developing swelling, redness or warmth over a bone or joint
• signs of sepsis such as fever, confusion, rapid heart rate or difficulty breathing

Your doctor will ask about your symptoms, examine you and refer you for tests. Tests used to help diagnose osteomyelitis include blood tests, x-rays and wound swabs.

Blood tests cannot diagnose osteomyelitis, but they may show signs of infection. A blood culture may be done to check if the infection is spreading and to identify the type of bacteria causing it.

Sometimes your doctor will take a tissue or bone biopsy, where they remove some cells for testing. They may refer you for imaging, such as x-rays, MRI, CT scan, bone scan or ultrasound.

Acute osteomyelitis is usually treated with antibiotics for at least 3 to 6 weeks. At first, you will need antibiotics intravenously (IV - through a vein), and later as oral tablets, when your symptoms improve.

For chronic osteomyelitis, you may need surgery to remove damaged bone or tissue. If you have infected plates or screws, surgery can also remove or replace them. You may need surgery if antibiotic treatment does not work or if your condition is severe.

Care at home

If your health improves after you have intravenous antibiotics in hospital, you may be able to go home. You may be able to go home with antibiotics in tablet form, or with planned outpatient intravenous therapy (known as 'hospital in the home'). It is important that you complete the course of antibiotics as your doctor prescribes, to reduce your chance of complications.

If you have any further signs or symptoms of osteomyelitis, have diarrhoea or a fever above 38.5°C, see your doctor.

If osteomyelitis is not treated early or does not respond well to treatment, it can lead to serious complications. These may include the following:

• Ongoing infection — the infection may not fully go away and can keep coming back.
• Dead bone (sequestrum) — parts of the bone may die and need to be removed with surgery.
• New bone growth (involucrum) — the body may grow new bone around the infection, which can make treatment harder.
• Abscesses — pockets of pus can form in or near the bone and may need to be drained.
• Weak or broken bones — the bone can become thin and more likely to break.
• Growth problems in children — if the infection affects growing bones, it can cause uneven limbs or deformities.
• Spread of infection — the infection can move to nearby joints or into the blood (sepsis), which can be life-threatening.

These complications show why it's important to find the illness quickly and get the right medical care.

There are steps you can take to lower your risk of getting osteomyelitis, especially if you have other health problems, such as diabetes or poor circulation. Here are some ways to help prevent it:

• Keep your wounds clean — wash all cuts, sores, or surgical wounds with clean water and cover them with a clean dressing.
• See a doctor for deep or infected wounds — don't ignore wounds that are red, swollen, warm, or leaking pus.
• Look after your skin and feet — check your skin often, especially if you have diabetes or reduced feeling in your feet.
• Manage all chronic health conditions — following your doctor's advice on how to care for long-term illness lowers your risk.
• Follow care instructions after surgery — always follow your health team's advice when caring for stitches, wounds or implants.
• Avoid injecting illegal drugs — sharing or using unclean needles increases your risk of serious infections, including in the bone.
• Get help early — see a doctor if you have ongoing pain, swelling, or a fever that doesn't go away.

If you think you have osteomyelitis you should see your doctor promptly.

• The Royal Children's Hospital has a fact sheet on osteomyelitis in children.
• SA Health has a consumer information sheet on osteomyelitis in children, including causes, signs and management.
• Arthritis Australia has information on a type of osteomyelitis called chronic recurrent multifocal osteomyelitis (CRMO).

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

If you are worried about osteomyelitis in children, call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available from 7am to midnight (AET), 7 days a week (including public holidays).