Osteomyelitis, A Growing Health Concern: Six Common Questions

Osteomyelitis, or an infection of the bone, occurs when bacteria travel through the bloodstream or an open wound, to a weakened spot in the bone or marrow. It is a growing concern in modern healthcare, particularly with the rise in antibiotic resistance to bacteria. Individuals with diabetes are at high risk of developing osteomyelitis because they are more susceptible to the development of chronic wounds, particularly on the feet or lower limbs. When coupled with diabetic neuropathy, a loss of sensation in the lower limbs, the condition can fester for months without the patient feeling any pain. 

Osteomyelitis can develop any time a bone is vulnerable or exposed: after a puncture wound or trauma, near a surgical site, after joint replacement, or as a complication after amputation. Approximately one in 675 U.S. hospital admissions each year (50,000 cases annually) is due to osteomyelitis. Patients with diabetes, immunocompromised individuals, and patients on hemodialysis are at increased risk. Here are answers to six common questions about osteomyelitis:

1.      How Does Osteomyelitis Present Itself?

When an infection reaches the bone, a lack of blood flow to the area deprives it of bacteria-fighting oxygen and the infection escalates, putting the patient at risk of bone death. Common symptoms of osteomyelitis include swelling and redness, a burning sensation, skin drainage (yellow pus), fatigue, fever, and pain. Specialized wound care is necessary to treat the condition and prevent the development of chronic or recurring osteomyelitis, which often requires ongoing care.

2.      What Do Diabetics Need to Know?

Individuals with diabetes are at very high risk of developing osteomyelitis on the bony structures of the lower limbs or feet as well as other parts of the body. Foot complications are the most frequent reason for patients with diabetes to be hospitalized, accounting for 25 percent of all admissions in the United States. It is estimated that 60 percent of diabetic foot ulcers are complicated by an infection and more than two thirds of this group suffers from lower limb amputation because of the infection.

3.      When is a Wound Care Consultation Needed?

If any wound has not healed in more than 30 days it’s important for patients to contact their primary physician for evaluation and consideration for referral to a wound care physician. Some insurances, including Medicare, allow for self referral to a specialized wound care center. If osteomyelitis is suspected, special care will be taken to diagnose and aggressively treat the infection in order to prevent the condition from deteriorating and leading to possible amputation.

4.      How is Osteomyelitis Diagnosed?

Osteomyelitis can be diagnosed by magnetic resonance imaging (MRI), bone culture, bone scan or bone biopsy (a piece of the bone is removed and tested for bacteria, most commonly Staphylococcus aureus). In addition, some blood tests may reveal elevated levels of white blood cells and other factors indicating that the body is fighting infection. 

5.      How is Osteomyelitis Treated?

Treatment for osteomyelitis includes aggressive antibiotics and surgical debridement to clean out the infected bone. Sometimes antibiotics do not penetrate the bone adequately enough to heal it. If osteomyelitis becomes chronic (lasting 6 weeks or longer) and refractive (not responding to treatment) it can be much more difficult to treat. In some cases, hyperbaric oxygen therapy (HBOT) may be prescribed in conjunction with an antibiotic regimen in order to improve outcomes

6.      What is Hyperbaric Oxygen Therapy (HBOT) and How Does it Treat Osteomyelitis?

During HBOT the patient is given 100 percent oxygen in a hyperbaric chamber with a technician nearby. Increased oxygen in the bloodstream greatly enhances the ability of white blood cells to kill bacteria, reduce swelling and allow new blood vessels to grow more rapidly into affected areas including the tissues and bones. Typically used as an adjunctive treatment along with an antibiotic regimen, 20-40 HBOT sessions are required to achieve sustained therapeutic benefit for patients with osteomyelitis.

If you or someone you know has a wound that is not healing or if osteomyelitis is suspected, a wound care and hyperbaric medicine specialist should be consulted as soon as possible. For more information, contact Covenant Wound Healing & Hyperbaric Medicine Center at 989.583.4401.


Posted Date: 10/13/2021

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