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Osteomyelitis, an infection of bone that leads to tissue destruction and often to debility, can be caused by a wide variety of bacteria (including mycobacteria) and fungi and may be associated with viral infections. Its management must be individualized and depends on numerous factors, including the causative organism, the specific bone involved, vascular supply, nerve function, foreign bodies, recent injury, the physiologic status of the host, and associated comorbidities. The spectrum of the disease can range from extensive (e.g., tibial and vertebral osteomyelitis) to localized (e.g., bone invasion associated with a tooth abscess). Two major classification systems for osteomyelitis are used in making decisions about medical therapy and surgery. Lee and Waldvogel categorized cases as acute or chronic, hematogenous or contiguous, and with or without vascular compromise. The Cierny and Mader classification system for long-bone osteomyelitis encompasses the location and extent of the infection as well as a number of other factors.

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Etiology (Table 126–1)

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Table 126–1 Microorganisms that Cause Osteomyelitis
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The foremost bacterial cause of osteomyelitis is Staphylococcus aureus. Gram-negative organisms such as Pseudomonas aeruginosa and Escherichia coli, coagulase-negative staphylococci, enterococci, and propionibacteria may also be involved. Mycobacterium tuberculosis is a common cause of osteomyelitis in countries with limited medical resources; other mycobacterial species that infect bone include M. marinum, M.chelonei, and M. fortuitum. Fungal etiologies include Candida, Coccidioides, Histoplasma, and Aspergillus species. Noninfectious pathogenic mechanisms that may cause disease mimicking osteomyelitis include avascular necrosis, rheumatoid diseases, neuropathy with chronic trauma, gout, and malignancies.

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The precipitating event(s) for osteomyelitis vary greatly. The prosthetic joint implants and stabilization devices that are increasingly being used in orthopedic surgery are associated with complex infections. Trauma is also a common ...

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