Prevention of Bone Infections
Trauma is unpredictable, making it impossible to avoid the inoculation causes of bone infections.
Penetrating wounds of the limbs should be probed for bone exposure or involvement and any open lacerations irrigated copiously.
Contiguous spread from other tissues is prevented by aggressive and scrupulous attention and therapy to infected tissues, especially in diabetics and others with peripheral vascular disease, and also in those who are immunocompromised (HIV, chemotherapy, and steroid patients).
- Strict glycemic control of diabetics: Aggressive management of pressure sores and bedsores in diabetics or patients who are immobilized, especially those in nursing or assisted-living facilities
- Avoid intravenous drug abuse which carries a high risk of bacteria
- Sickle cell anemia vigilance for the need for transfusion: Sickling of red blood cells can occlude the blood supply to bone, especially relevant in hip necrosis in these patients
- Frequent assessments for infection in patients on chemotherapy: immunosuppression (transplant patients), and patients with peripheral vascular disease (arteritis, claudication, atherosclerosis, or venous stasis)
- Smoking cessation if smoking: Nicotine is a powerful vasoconstrictor that can make vascular compromise much worse
- Altering steroid therapy: For rheumatic inflammatory diseases when obvious soft tissue infection is present
Hematogenous spread can be prevented by early identification treatment for bacteremia or sepsis in hospitalized patients and dialysis patients.