In tubercular osteomyelitis, the long bones and vertebrae are the ones that tend to be affected.Staphylococcus aureus is the organism most commonly isolated from all forms of osteomyelitis.Bloodstream-sourced osteomyelitis is seen most frequently in children, and nearly 90% of cases are caused by Staphylococcus aureus. In infants, S. aureus, Group B streptococci (most common) and Escherichia coli are commonly isolated; in children from one to 16 years of age, S. aureus, Streptococcus pyogenes, and Haemophilus influenzae are common. In some subpopulations, including intravenous drug users and splenectomized patients, Gram-negative bacteria, including enteric bacteria, are significant pathogens.The most common form of the disease in adults is caused by injury exposing the bone to local infection. Staphylococcus aureus is the most common organism seen in osteomyelitis, seeded from areas of contiguous infection. But anaerobes and Gram-negative organisms, including Pseudomonas aeruginosa, E. coli, and Serratia marcescens, are also common. Mixed infections are the rule rather than the exception.Systemic mycotic infections may also cause osteomyelitis. The two most common are Blastomyces dermatitidis and Coccidioides immitis.In osteomyelitis involving the vertebral bodies, about half the cases are due to S. aureus, and the other half are due to tuberculosis (spread hematogenously from the lungs). Tubercular osteomyelitis of the spine was so common before the initiation of effective antitubercular therapy, it acquired a special name, Potts disease.The Burkholderia cepacia complex has been implicated in vertebral osteomyelitis in intravenous drug users.
In reality, there are no distinct subtypes; instead, there is a spectrum of pathologic features that reflects a balance between the type and severity of the cause of the inflammation, the immune system and local and systemic predisposing factors. Suppurative osteomyelitis
Acute suppurative osteomyelitis
Chronic suppurative osteomyelitis
Primary (no preceding phase)
Secondary (follows an acute phase)
Non-suppurative osteomyelitis
Diffuse sclerosing
Focal sclerosing (condensing osteitis)
Proliferative periostitis (periostitis ossificans, Garrés sclerosing osteomyelitis)
OsteoradionecrosisOM can also be typed according to the area of the skeleton in which it is present. For example, osteomyelitis of the jaws is different in several respects from osteomyelitis present in a long bone. Vertebral osteomyelitis is another possible presentation. Treatment
Osteomyelitis often requires prolonged antibiotic therapy for weeks or months. A PICC line or central venous catheter can be placed for long-term intravenous medication administration. Some studies of children with acute osteomyelitis report that antibiotic by mouth may be justified due to PICC-related complications. It may require surgical debridement in severe cases, or even amputation. Antibiotics by mouth and by intravenous appear similar.Due to insufficient evidence it is unclear what the best antibiotic treatment is for osteomyelitis in people with sickle cell disease as of 2019.Initial first-line antibiotic choice is determined by the patients history and regional differences in common infective organisms. A treatment lasting 42 days is practiced in a number of facilities. Local and sustained availability of drugs have proven to be more effective in achieving prophylactic and therapeutic outcomes.