Osteomyelitis in Emergency Medicine Treatment & Management

Updated: Nov 03, 2022
  • Author: Randall W King, MD, FACEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
  • Print

Emergency Department Care

Osteomyelitis rarely requires emergent stabilization or resuscitation. The primary challenge for ED physicians is considering the appropriate diagnosis in the face of subtle signs or symptoms.

Treatment for osteomyelitis involves the following:

  • Initiation of intravenous antibiotics that penetrate bone and joint cavities

  • Referral of the patient to an orthopedist or general surgeon

  • Possible medical infectious disease consultation

Select the appropriate antibiotics using direct culture results in samples from the infected site, whenever possible. Empiric therapy is usually delayed when possible until culture results can be obtained to better target definitive future antibiotic coverage. Empiric therapy is often initiated on the basis of the patient's age and the clinical presentation. Therapy should always include coverage for S aureus and consideration of CA-MRSA. Further surgical management may involve removal of the nidus of infection, implantation of antibiotic beads or pumps, hyperbaric oxygen therapy, [18] or other modalities.

Diagnosis requires 2 of the 4 following criteria:

  • Purulent material on aspiration of affected bone

  • Positive findings of bone tissue or blood culture

  • Localized classic physical findings of bony tenderness, with overlying soft-tissue erythema or edema

  • Positive radiological imaging study



Order an orthopedics, general surgery, and/or infectious disease consultation, as needed. Patients with diabetic foot osteomyelitis are best cared for by a multidisciplinary team. [19]



Acute hematogenous osteomyelitis can potentially be avoided by preventing bacterial seeding of bone from a remote site. This involves the appropriate diagnosis and treatment of primary bacterial infections.

Direct inoculation osteomyelitis can best be prevented with appropriate wound management and consideration of prophylactic antibiotic use at the time of injury.


Long-Term Monitoring

Patients with vertebral osteomyelitis whose pain resolves after antibiotic treatment or surgery generally do not require repeat MRI. [11, 12]