How Do I Manage Bone Infections??
Treatment of bone infections involves the three standard approaches to any serious tissue-destructive infection:
- Debridement: surgical removal of necrotic tissue must accompany antibiotic therapy to expect improvement. This may include removal of implanted metal materials previously used for other reasons but now clearly involved in the bone infection.
- Antibiotic therapy: Based on the bone biopsy-directed culture and sensitivity of the infectious organism(s).
- Therapy: Over time sufficient to treat infection based on an individualized assessment of the types of bacteria involved, the anatomic site, and the local environment (devascularized? immunosuppressed?) where the infection resides.
Antibiotic therapy for osteomyelitis is typically lengthy. Parenteral (intravenous) antibiotics can be given in the hospital, nursing facility, or as an outpatient via home health nursing. A signal that the duration has been long enough is when all debrided bone has been covered by well-vascularized soft tissue (≥ 6 weeks). If there is involved hardware that mustn’t be removed, the course of parenteral antibiotics is continued via oral antibiotics.
Other therapies for stubborn infections include hyperbaric oxygen that aids the function of the blood supply and negative pressure wound therapy (“vacuum-assisted closure,” or NPWT). NPWT suctions the healing areas such that the tissue collapses to reapproximate, without the dissection effects of secretions.