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Osteomyelitis

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osteomyelitis diagnosis treatment guidelines adult 2025

Osteomyelitis is an infection of bone, usually caused by bacteria, most commonly Staphylococcus aureus. It can occur after infection spreads through the bloodstream, from nearby tissue such as a diabetic foot ulcer, or after trauma, surgery, or implanted hardware.
Common features
  • Localized bone pain, tenderness, warmth, swelling
  • Fever or feeling unwell, though this may be absent in chronic disease
  • A nonhealing wound or draining sinus
  • In vertebral infection: persistent back pain, sometimes fever or neurologic symptoms
Diagnosis
  • Blood tests: inflammatory markers such as CRP and ESR
  • Blood cultures when systemic infection is suspected
  • Plain X-ray is usually first, but can be normal early on
  • MRI is generally the preferred imaging test
  • Bone biopsy with culture is the best way to identify the organism and guide antibiotic choice, when feasible. The AAFP clinical review summarizes this approach.
Treatment
  • Culture-directed antibiotics, often for about 6 weeks, with IV and/or high-bioavailability oral therapy depending on the infection and patient
  • Drainage or surgical debridement if there is an abscess, dead bone, hardware infection, poor response to antibiotics, or spinal/neurologic compromise
  • Treating contributing issues, such as impaired blood flow, diabetes, pressure injury, or an infected ulcer
Seek urgent medical care now for fever with severe bone/back pain, rapidly spreading redness, a deep/nonhealing foot wound, new weakness or numbness, bowel/bladder changes, or signs of sepsis such as confusion, low blood pressure, or fast breathing.
The details differ substantially for acute childhood disease, diabetic foot osteomyelitis, chronic post-traumatic infection, and vertebral osteomyelitis. What would you like: symptoms, diagnosis, treatment, nursing/exam notes, or a specific case?
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