Osteomyelitis is an infection of the bone caused by bacteria, fungi, or mycobacteria. The infection can land in the bone via the bloodstream (hematogenous spread), contiguous spread from adjacent soft tissues, or direct inoculation during trauma, or surgery. The disease process is characterized by the progressive destruction of bone at the center of infection and new appositional bone growth around it. Osteomyelitis is found in both adults and children, though its presentation and prognosis are different in the two groups. Pediatric patients, whose bones have open growth plates, are accordingly more susceptible to infection, but this infection is likewise more amenable to antibiotic treatment. By contrast, osteomyelitis in adults often requires surgical debridement and still has poorer outcomes, owing to both host and disease factors. The major risk factors for osteomyelitis include diseases that compromise the immune system, IV drug use, vascular disease, diabetes mellitus, sickle cell anemia, peripheral neuropathy, prior trauma, and retained orthopaedic implants.
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