Management of osteomyelitis.

Early diagnosis and aggressive treatment, which includes thorough debridement and culture-directed antibiotic therapy, are essential for effective management of patients with osteomyelitis. Definitive diagnosis of osteomyelitis usually requires microbial culture of bone specimens obtained either by surgery or by percutaneous needle biopsy. The most common pathogen involved in osteomyelitis is Staphylococcus aureus; however, other organisms, including gram-negative pathogens and coagulase-negative staphylococci, may be found. Often, bone infections may be polymicrobial. Antimicrobial therapy, ideally initiated after complete surgical debridement and microbial confirmation of the diagnosis, is usually maintained for at least 6 weeks. Although therapy has traditionally been administered parenterally during an extended hospital stay, oral antibiotic therapy (often following initial parenteral therapy) and parenteral therapy on an outpatient basis are gaining acceptance for use in patients with osteomyelitis.