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Bone Infections

How to tell if bone pain and difficulty moving are caused by a bacterial infection.
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Written by
Cindy Lai, MD.
Medically reviewed by
Last updated April 15, 2021

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What is a bone infection?

A bone infection, also called osteomyelitis, occurs when bacteria invade and infect the bones. Cuts, wounds, and traumatic injuries can lead to a bone infection. Bacteria enter the body through the broken skin of the wound and infect nearby bones.

The infection can also spread through the bloodstream and infect bones and other organs. Adults with diabetes, circulatory illnesses, and implanted prosthetic hardware (such as a joint replacement) may be more susceptible to bone infections.

In children, the cause of bone infections often can’t be identified.

Treatment is more successful if you see your doctor as soon as possible. Acute (new) bone infections are generally easier to treat than chronic (long-term) infections.

Most common symptoms

Pro Tip

One important question to ask your doctor about osteomyelitis is “Will I need surgery?” Adults with osteomyelitis often need surgery to clean out the area surrounding the infected bone and sometimes remove the infected bone itself. —Dr. Elizabeth Grand

Symptoms vary depending on your age, the location of the infected bone, and other risk factors. Common symptoms include redness and swelling of the skin above the infected bone. The bone may hurt when you move or even when standing still.

If you have a new infection, the symptoms may worsen over a few days. In chronic infections, symptoms may develop over weeks or months and worsen as the infection progresses.

Main symptoms

  • Pain in the infected bone, which may start as dull and become severe
  • Pain with or without movement
  • Redness, swelling, or warmth around the area of infection
  • Fever and chills

Other symptoms you may have

  • New neck or back pain (if the bones of the back are infected)
  • Difficulty walking (if the foot or hip is infected)
  • Irritability (in children)
  • Fatigue
  • Changes in skin near the affected area (such as ulcers or purplish-black discoloration)

Next steps

If you suspect you have a bone infection, see your doctor right away. If you have a high fever or severe pain, however, you should go to the ER.

Without treatment, bone infections can worsen and lead to sepsis, which is a life-threatening condition. Other complications of untreated bone infections include bone fracture, deformity, and bone death. In bone death, also known as osteonecrosis, the infected bone needs to be removed. Untreated bone infection in children can result in stunted growth.

Treatment

Pro Tip

The treatment of osteomyelitis can be a long process. Sometimes people need IV antibiotics for several weeks. It may feel like the treatment is neverending, but it is extremely important to stay on track with taking your antibiotics and following up with your doctor for any blood or imaging tests. —Dr. Grand

You’ll be seen by a team of specialists, which may include infectious disease doctors, surgeons, and wound care nurses.

Before treatment begins, your doctors will do a thorough exam to look for wounds. They’ll also order blood tests, a wound culture, and imaging tests such as an X-ray, CT, or MRI. These tests will help locate the infected bone, evaluate if the infection has spread to other areas, and identify the type of bacteria that is causing the infection. If you have a severe infection, you may need to stay in the hospital for a few days or even weeks.

Medication

Bone infections are treated with antibiotics. The specific antibiotic you’ll get will depend on which bacteria is causing the infection. Antibiotics are typically given intravenously (IV). In this case, you need a temporary IV catheter placed in the arm to receive the antibiotics.

Your doctors may start you on one antibiotic and then switch you to a different one later on. This can happen because it may take a few days for test results that identify the bacteria to come back.

When the results come back, doctors will select an antibiotic that best targets the bacteria causing your infection. This antibiotic may be IV, in which case you will be sent home with an IV catheter, or it may be an oral antibiotic in pill form. The decision to treat with IV or oral antibiotics may also depend on whether or not you had surgery to treat the bone infection.

Because bone infections are harder to treat than most other types of infections, people usually take antibiotics for several weeks (usually 4 to 6 weeks, but sometimes longer).

Surgery

In some cases, surgery may be needed. The decision to operate depends on which bones and other tissues are infected and how severe the infection is. In severe cases of bone infection from ulcers, dead tissue and bone may need to be surgically removed to prevent the infection from spreading throughout the body.

If the infection was caused by surgery, such as a knee replacement, the infected metal implants may need to be removed while the infection is treated.

Follow up

Because bone infections can take a long time to treat, it’s important that you take antibiotics as prescribed. Visiting nurses may be assigned to come to your home and help set up and monitor your IV antibiotics.

It’s also important to go to all of your follow-up appointments. These allow your doctors to check on your progress, run more blood and imaging tests, and make sure that antibiotics are not stopped too early.

If you have severe open wounds or ulcers, you may need to visit your doctor a few times to have the bandages and dressings covering them changed. A visiting nurse may also come to your home to help with that.

Causes

Bone infections are usually caused by bacteria, which can enter the body through a cut, a wound, or injury, or during surgery or other invasive medical procedures.

Some common bacteria that cause bone infections are:

  • Staphylococcus aureus (most common)
  • Other types of Staphylococcus bacteria
  • Streptococcus
  • Enterococcus
  • Anaerobic bacteria

In rare cases, fungi or uncommon bacteria such as mycoplasma can infect the bone.

Risk factors

  • Traumatic injuries involving the bones, such as an open fracture (occurs when a broken bone protrudes through the skin).
  • Recent surgery involving the bones, such as a knee or hip replacement or procedures to fix broken bones.
  • Diabetes, especially if you’ve had diabetes for a long time and you have foot ulcers or sores.
  • Peripheral vascular disease (diseased blood vessels from diabetes, smoking, kidney problems, etc.).
  • Pressure ulcers that may develop from spending a lot of time in bed or a wheelchair.
  • Having certain other bacterial infections such as endocarditis (infection of the heart valves).
  • IV drug use

Less common risk factors

  • Immunocompromised (such as cancer treatment, long-term steroid use, or diseases that impair the immune system)
  • Presence of a chronic urinary catheter (a tube that enters the bladder)
  • Presence of a central line (a tube that enters the veins)
  • Kidney disease requiring hemodialysis.
  • History of splenectomy (spleen removal)
  • Sickle cell anemia

Bone infections in children

Dr. Rx

It’s not likely that a person will die from osteomyelitis. Most of the time, If osteomyelitis is diagnosed quickly, it can be treated successfully with antibiotics and surgery. Unfortunately, sometimes osteomyelitis is associated with a life-threatening condition called sepsis. Sepsis is when an infection is so bad that the body becomes overwhelmed and major organs start to fail.  In the most severe cases, this can result in death. —Dr. Grand

Bone infections can occur in children without obvious wounds, broken bones, diabetes, or other risk factors that are common in adults. In children, bone infections typically occur in the long bones of the legs and arms, which may affect their growth later on.

Children who have a bone infection may complain about pain or difficulty moving their legs or arms. Other symptoms in children include fever and redness and swelling at the site of the affected bone or joint. Infants and toddlers may also be irritable and lethargic.

Early treatment is very successful in curing bone infections in children. It is extremely important to detect and treat osteomyelitis as soon as possible in children to prevent sepsis, which can be life-threatening, and other complications such as abscess and bone death, which typically require surgery.

Preventative tips

Bone infections can sometimes be random and hard to prevent. However, if you have a cut or wound, there are many steps you can take to prevent a bone infection. These include keeping the cut or wound clean, dry, and covered. It is also important to monitor the wound for any worsening redness, swelling, or warmth, and to notify your doctor if you develop any of these symptoms.

For people with diabetes, the best ways to prevent bone infections are to wear comfortable shoes and check your feet often for ulcers. You should also check for cuts or wounds on your entire body. People with diabetes should see a podiatrist (a foot doctor) to help monitor the feet, and order special shoes to prevent ulcers.

Keeping your blood sugar under control and managing your diabetes are crucial too. This helps your blood vessels and immune system stay healthy enough to fight off infections before they reach the bone. It also keeps the nerves in the feet and hands intact so you can sense pain if you are injured.

If you’re at risk of getting pressure ulcers because of time spent in bed or a wheelchair, change position whenever possible. This way you won’t put too much pressure on any one part of your body, which is what leads to a sore.

People with urinary catheters and other external tubing, such as a dialysis catheter, should make sure these areas are kept clean to prevent any bacteria from entering the body.

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