J Caimpolini K G Harding
Definition
Osteomyelitis is an infection of the bone. It can happen in any bone in the body, but it most often affects the long bones (leg and arm), the spine, and foot bones. it can caused by bacterial infection (usually from Staphylococcus) or, more rarely, a fungal infection
Acute osteomyelitis occurs with a rapid onset and is usually accompanied by the symptoms of pain, fever, and stiffness. It generally occurs after a break in the skin from injury, trauma, surgery, or skin ulceration from wounds. Chronic osteomyelitis is insidious (slow) in onset. It may be the result of a previous infection of osteomyelitis. Despite multiple courses of antibiotics, it may reoccur. Symptoms of chronic osteomyelitis are subtle but may include fever, pain, redness, or discharge at the site of infection.
Epidemiology
Approximately 20% of adult cases of osteomyelitis are hematogenous, which is more common in males for unknown reasons.
Acute bacterial osteomyelitis carried 50 % mortality in the preantibiotic era because of overwhelming sepsis with metatasic abses. Althought antimicrobial drugs have dramatically changed the prognosis of the acut hematogenous form, chronic bacterial osteomielitis remains a challenging medical problem
In this review, we analyse the current understanding of chronic osteomielitis by focussing on how bacteria succeed in overcoming both host defence mechanism and the antibiotic agents
Micro-organism
The typical causative agent is S areus, or salmonela epidermidis if associated with an implant. Gram negative bacteria are present in about one third of case Chronic osteomyelitis in the diabetic foot is polymicrobial with mixed Gram positive and Gram negative bacteria (aerobes and anaerobes). Wound swabs are all too often inaccurate in chronic osteomyelitis: cultures from operative specimens are a more reliable method of planning antibiotic treatment.
infection
chronicity
Healthy bone is extremely resistant to infection. However, once an infection has established, its eradication by antibiotic treatment is very difficult. Dead bone and implants are the most common reasons for failure of conservative treatment. Under those circumstances bacteria cannot be reached by host defence mechanisms or antibiotics. The presence of an implant causes exhaustion of local polymorphonuclear cells that become unable to kill phagocytosed bacteria.
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