Osteomyelitis: microbiologic, clinical, and therapeutic considerations

A distinction between "acute" osteomyelitis and "chronic" osteomyelitis is difficult on both clinical and histopathologic grounds. The classification of osteomyelitis into three groups (hematogenous osteomyelitis, osteomyelitis secondary to a contiguous focus of infection, and osteomyelitis associated with vascular insufficiency) allows the physician to clearly distinguish among the types of infection on the bases of (1) the pathogenesis, (2) the bones involved, (3) the microorganisms responsible, and (4) the therapy. When antimicrobial agents are administered to a patient with any form of osteomyelitis, a bactericidal antibiotic should be employed, if possible. If feasible, a parenteral route of administration should be utilized, and therapy should be administered for a prolonged period of time. When more than one bactericidal antibiotic has been demonstrated to be effective against the isolated microorganisms, the least toxic agent should be selected.