Challenges and Management Approaches for Osteomyelitis (Bone Infections)

Osteomyelitis is an infection of the bone which can happen from a variety of causes such as spread from another source of infection in the body or following surgery (fracture, joint replacement, arthroscopy for sports injuries). The number of major injuries & orthopaedic surgeries have exponentially increased over the last decade. At the same time, risk for infection with multi-drug resistant bacteria has also increased due to an ageing population with issues such as diabetes, kidney failures and long term steroid use.

What makes orthopedic infections difficult to manage?

Orthopedic infections pose significant challenges due to their unique nature. The complexity arises from the fact that most orthopedic surgeries involve the use of implants, such as plates, screws, rods, or artificial joints. In cases of infection, these foreign objects create an ideal sanctuary for bacteria to thrive, allowing them to conceal and multiply within the bone structure and around the implants. This particular aspect of orthopedic infections intensifies the difficulty in treating and eliminating them effectively.

Why is a collaborative approach necessary for managing orthopedic infections?

The primary approach to managing orthopedic infections typically involves surgical intervention by orthopedic surgeons, who clean and treat the affected wound, bone, or implant. To determine the extent of the infection, various imaging techniques such as X-rays, CT scans, MRI scans, and occasionally PET scans are utilised. Microbiologists perform culture tests to identify the specific microorganism responsible for the infection and determine which antibiotics would be effective. Infectious disease specialists then select appropriate antibiotics based on factors such as their toxicity and ability to penetrate bones. Additionally, plastic surgeons may be involved in addressing any skin and soft tissue defects associated with these infections.

What factors increase the risk of developing an orthopedic infection?

The following factors can increase the risk of orthopaedic infections: diabetes, smoking, tobacco use, chronic steroid usage, rheumatoid disorders, immunodeficiency, fractures accompanied by wounds from high-velocity road traffic accidents, and a previous history of pulmonary tuberculosis (which can lead to tuberculosis affecting the bones and joints).

What are the indicative signs that raise suspicion of an orthopaedic infection?

If you experience any of the following symptoms, it is important to consult your doctor as they may indicate an underlying issue:

• Continuous pain, even at rest, accompanied by swelling, redness, and warmth around a bone or joint.
• Presence of discharge or a wound in the foot in a known diabetic.
• Surgical site infection is characterised by persistent or new discharge from the surgical site.
• Persistent or worsening pain that is disproportionate or experienced even during periods of rest.
• Fever that persists for more than 48 hours, after ruling out other medical causes.
• Redness and warmth in the affected area.

If any of these symptoms occur, it is recommended to seek a medical review from your doctor.

Is antibiotic treatment sufficient to eliminate the infection on its own?

In many cases, empirical antibiotic treatment without knowledge of the specific bacteria and appropriate antibiotics may not be effective in 2023. Moreover, this approach can contribute to the development of drug resistance. Additionally, bacteria have the ability to form protective structures called biofilms, which make it difficult for antibiotics to completely eradicate the infection. Therefore, it is important to address biofilm removal in order to effectively treat and eliminate the infection.

Conclusion

A combination of early detection, appropriate investigations and timely multi-disciplinary approach can help achieve the best outcome in orthopaedic infections. If you or a loved one are experiencing any symptoms of Osteomyelitis, book an appointment with  Dr. Kshitij Chaudhary, Consultant - Spine Surgeon P. D. Hinduja Hospital & Medical Research Centre, Mahim, Mumbai. Contact: 022 6766 8181/022 4510 8181

*Information source: Bombay Times