Introduction

Osteomyelitis is a severe infection of the bone, bone marrow, and surrounding soft tissue. Although
Staphylococcus aureus is a common cause of infection, a variety of microorganisms may cause
osteomyelitis. The infecting microorganisms can invade by indirect or direct entry. The indirect entry
(hematogenous) of microorganisms most frequently affects growing bone in boys younger than 12 years
old, and is associated with their higher incidence of blunt trauma. Adults with vascular insufficiency
disorders (e.g., diabetes mellitus) and genitourinary and respiratory tract infections are at higher risk for a
primary infection to spread via the blood to the bone. The pelvis, tibia, and vertebrae, which are vascular-
rich sites of bone, are the most common sites of infection. Direct entry osteomyelitis can occur at any age
when there is an open wound (e.g., penetrating wounds, fractures) and microorganisms gain entry to the
body. Osteomyelitis may also occur in the presence of a foreign body such as an implant or an orthopedic
prosthetic device (e.g., plate, total joint prosthesis).

Bone becomes infected by one of three modes:

Extension of soft tissue infection (eg, infected pressure or vascular ulcer, incisional infection)
Direct bone contamination from bone surgery, open fracture, or traumatic injury (eg, gunshot wound)
Hematogenous (bloodborne) spread from other sites of infection (eg, infected tonsils, boils, infected teeth,
upper respiratory infections). Osteomyelitis resulting from hematogenous spread typically occurs in a bone
area of trauma or lowered resistance, possibly from subclinical (nonapparent) trauma.

After gaining entry into the blood, the microorganisms grow, resulting in an increase in pressure because
of the nonexpanding nature of most bone. This increasing pressure eventually leads to ischemia and
vascular compromise of the periosteum. The infection spreads through the bone cortex and marrow cavity,
ultimately resulting in cortical devascularization and necrosis. Once ischemia occurs, the bone dies. The
area of devitalized bone eventually separates from the surrounding living bone, forming sequestra. The part
of the periosteum that continues to have a blood supply forms new bone called involucrum. It is difficult
for blood-borne antibiotics or white blood cells (WBCs) to reach the sequestrum. A sequestrum may
become a reservoir for microorganisms that spread to other sites, including the lungs and brain. If the
sequestrum does not resolve on its own or is debrided surgically, a sinus tract may develop, resulting in
chronic, purulent cutaneous drainage.

Patients who are at high risk for osteomyelitis include those who are poorly nourished, elderly, or obese.
Also at risk are patients with impaired immune systems, those with chronic illness (eg, diabetes, rheumatoid
arthritis), and those receiving longterm corticosteroid therapy.

Postoperative surgical wound infections occur within 30 days after surgery. They are classified as incisional
(superficial, located above the deep fascia layer) or deep (involving tissue beneath the
deep fascia). If an implant has been used, deep postoperative infections may occur within a year. Deep
sepsis after arthroplasty may be classified as follows:

Stage 1, acute fulminating: occurring during the first 3 months after orthopedic surgery; frequently
associated with hematoma, drainage, or superficial infection
Stage 2, delayed onset: occurring between 4 and 24 months after surgery
Stage 3, late onset: occurring 2 or more years after surgery, usually as a result of hematogenous spread

Bone infections are more difficult to eradicate than soft tissue infections because the infected bone becomes
walled off. Natural body immune responses are blocked, and there is less penetration by antibiotics.
Osteomyelitis may become chronic and may affect the patients quality of life.

Osteomyelitis caused by Staphylococcus aureus is usually associated with a pressure ulcer or vascular
insufficiency related to diabetes mellitus. Osteomyelitis caused by Staphylococcus epidermidis is usually
associated with indwelling prosthetic devices from joint arthroplasty. Osteomyelitis caused by Neisseria
gonorrhoeae is usually associated with gonorrhea. Osteomyelitis caused by Pseudomonas is usually
associated with IV drug use

Clinical Manifestations and Complications

The patient will exhibit typical signs of inflammation and infection, including localized pain and warmth.
Acute osteomyelitis refers to the initial infection or an infection of less than 1 month in duration. The
clinical manifestations of acute osteomyelitis are both local and systemic. Local manifestations include
constant bone pain unrelieved by rest that worsens with activity; swelling, tenderness, and warmth at the
infection site; and restricted movement of the affected part. Systemic manifestations include fever, night
sweats, chills, restlessness, nausea, and malaise. Later signs include drainage from cutaneous sinus tracts
or the fracture site.

Chronic osteomyelitis refers to a bone infection that persists for longer than 1 month or an infection that
has failed to respond to the initial course of antibiotic therapy. Chronic osteomyelitis is either a continuous,
persistent problem (a result of inadequate acute treatment) or a process of exacerbations and remissions.
Systemic signs may be diminished, with local signs of infection more common, including constant bone
pain and swelling and warmth at the infection site. Over time, granulation tissue turns to scar tissue. This
avascular scar tissue provides an ideal site for continued microorganism growth that cannot be penetrated
by antibiotics. Long-term and mostly rare complications of osteomyelitis include septicemia, septic
arthritis, pathologic fractures, and amyloidosis.

Diagnostic Studies
A bone or soft tissue biopsy is the definitive way to determine the causative microorganism. The patients
blood and wound cultures are frequently positive for microorganisms. An elevated WBC count, erythrocyte
sedimentation rate (ESR), C-reactive protein levels may also be found. X-ray signs suggestive of
osteomyelitis usually do not appear until 10 days to weeks after the initial clinical symptoms, by which
time the disease will have progressed. Radionuclide bone scans (gallium and indium) are helpful in
diagnosis and are usually positive in the area of infection. Magnetic resonance imaging (MRI) and
computed tomography (CT) scans may be used to help identify the extent of the infection.3

In acute osteomyelitis, early x-ray findings demonstrate soft tissue swelling. In about 2 weeks, areas of
irregular decalcification, bone necrosis, periosteal elevation, and new bone formation are evident.
Radioisotope bone scans, particularly the isotope labeled white blood cell (WBC) scan, and magnetic
resonance imaging (MRI) help with early definitive diagnosis.Wound and blood culture studies are
performed to identify appropriate antibiotic therapy. With chronic osteomyelitis, large, irregular cavities,
raised periosteum, sequestra, or dense bone formations are seen on x-ray. Bone scans may be performed to
identify areas of infection. Anemia, associated with chronic infection, may be evident. The abscess is
cultured to determine the infective organism and appropriate antibiotic therapy.

The Diagnosis of osteomyelitis is based on bone scans, magnetic resonance imaging, blood tests and
biopsy.

Magnetic Resonance Imaging (MRI) can show epidural abscesses and other soft-tissue processes
accompanying osteomyelitis
Computed Tomography (CT) scan is used to detect sequestra, sinus tracts and soft-tissue
abscesses.
Radionucleotide bone scans help determine if infection is active and differentiate between
infectious and noninflammatory bone changes.
Erythrocyte sedimentation rate (ESR) and WBC are elevated in an acute infection
Blood and tissue cultures (from affected bone or soft tissue) are obtained to identify the infecting
organism and direct antibiotic therapy.

Computed Tomography Scan

Computed Tomography scan highlight differences in bone and soft tissue. The images are
generated by computerized synthesis of x-ray data obtained in many different directions in a cross-sectional
plane or slice. The computed data are assembled as three-dimensional images. CT is use to identify space-
occupying lesions (masses) and shifts of structures caused by neoplasms, cyst, focal inflammatory lesions,
and abscesses of head, chest, abdmen, pelvis, and extremities. To distinguish normal tissue from abnormal
masses, a contrast medium (dye) may be administered. The CT scan can be performed quickly, within 20
minutes, not including analysis (Black, Hawks 2008)

Nursing Responsibilities (Preprocedure Care)

1. Ensure informed consent and answer questions about procedure
2. Explain that fasting usually is not required for CT scan of the head, but usually required for the
abdomen
3. Explain that a contrast agent is commonly given, so ask about allergies to iodine or contrast dyes.
*some clients are given contrast agents even though they report contrast allergy. To reduce the
severity of the action, these clients are pretreated with an antihistamine or corticosteroid.
Therefore, do not assure client that a contrast agent will not be given (for patient with allergy)
 4. Tell the client that it is normal to feel a hot, flushed sensation and metallic taste in the mouth when
the dye is injected. Also tell the client to report difficulty breathing or itching to the staff in
radiology department
5. If CT scan is of the head, remove any objects from the hair (wigs, earrings, hairpins) before test
begins. The clients hair should be combed and smooth
6. Explain clients role during scan. The client is positioned supine and a body part to be scanned is
placed into the doughnut shaped ring of the scanner. The client can expect to hear mechanical
noises coming from the scanner.
7. Some clients may feel claustrophobic during the test, assure that it is possible to communicate with
the technician.
8. Emphasize that the client must remain still during the scan. If unable to compy, sedation or even
general anesthesia may be required. If sedation is needed, tell the client to avoid alcohol and
caffeine on the day of the scan, avoid eating for 2 hours before the scan, and arrange for someone
to drive home after the scan, and avoid driving for atleast 12 hours after the scan.

Pos-tprocedure Care
1. Diuresis will occur shortly after use of contrast agent. Encourage drinking plenty of fluids to flush
the dye and prevent nephrotoxic injury
2. The client may resume normal activities unless additional diagnostic tests are planned

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is a noninvasive test that uses powerful magnetic fields and
radiofrequency pulses to produce the image; therefore, the client is not exposed to ionizing radiation. The
magnet in the scanner is 30,000 times more powerful than the earths magnetic field. Consequently, this
test cannot be performed if clients have pacemakers, metal implants, some types of ventilators, or embedded
metal fragments, such as shrapnel. The powerful magnet may move these objects inside the clients body
or may interfere with their function. MRIs also are not performed for pregnant clients.
When looking at an MRI study, the image is opposite to that of a CT scan: Bone appears black on
an MRI scan and white on a CT scan. A contrast agent may be used to augment the images.

Pre-procedure care

Explain the purpose of the MRI scan, sounds and sensations that the client will hear and
feel during the examination, and the clients role during the test. Obtain informed consent.
Before the test, the client should remove all metal containing objects (brassiere, jewellery,
watches, and so on). Note the presence of any internal metal objects, such as prosthesis or
pacemaker for the physician. Intravenous fluid pumps need to be moved during the test.
Special MRI-compatible monitoring devices, such as pulse oximeters and
electrocardiogram leads, can be used.
The client can eat normally and take prescribed medications before an MRI scan of the
head. When the scan involves the GI system, the client must fast for 6 hours before the
procedure. Tell the client to lie still during the procedure, which can take from 60 to 90
minutes. Clients who are agitated or unable to remain motionless may require sedation
(instructions under Computed Tomography: Preprocedure care). If a contrast agent is
planned, ask whether the client tends to become nauseaTed easily, and adjust the intake of
food and fluids accordingly.
The client lies supine on a narrow, padded table. Because the scanner makes loud changing
noises, the client should wear earplugs or headphones. Some clients may feel
claustrophobic during the test; assure them it is possible to communicate with the
technician.

Post procedure Care

After the test, the client to increase fluid intake also may resume previous activities and diet. Tell client to
expect to experience diuresis.
Bone Scan and Gallium Scan
Client preparation

Assess the clients understanding of the procedure, providing explanation, clarification and
emotional support as needed.
Radioactive material (techneticum-99m phosphate) is injected intravenously for 2 to 3 hours
so that it concentrates in the bone.
Observe the injection site for redness or swelling. If a hematoma forms, apply warm soaks to
the area.
Have the client drink four to six glasses of water in the 2 to 3-hour waiting period before the
procedure to facilitate renal clearance of any circulating radioactive material.
The client is not restricted to foods of fluids prior to the exam.
Have the client empty the bladder prior to testing; a full bladder will mask the pelvic bones
and make the client uncomfortable
The scan takes about 30 to 60 minutes to complete. The client must remain still during the
scanning.
The client may be active during the waiting period
A sedative should be ordered and administered to any client who may have difficulty lying
quietly.

Postprocedure Care

No specific care is needed after the procedure

Client and Family Teaching

Remove jewelry or any metal objects that may hide X-ray visualization of the bones
The scanner machine moves over the body and detects radiation emitted by the skeleton. X-ray
films are prepared, showing a two-dimensional view of the skeleton. You may have to be repositioned
several times
The scanning machine makes a clicking sound
Drinking fluids and frequent activity in the first 6 hours after the procedure help reduce excess
radiation to the bladder and gonads
Family members will not be affected by the radionuclide, nor will urine or feces need special
handling before, during, or after the procedure

Gallium Scan
Client Preparation

Prepare as for a bone scan

Radioactive material, gallium-67, is injected intravenously 24 to 72 hours prior to the
examination
Gallium is used because of its high affinity for soft-tissue abscess

Postprocedure Care

Additional Imaging may be performed at 24-hour intervals to differentiate normal activity from
pathologic concentrations
No specific care is needed after the procedure

Client and Family Teaching

Refer to bone scan discussion

After a gallium scan, X-ray films may be obtained in 24-hour intervals for comparative results

Medical Management
The initial goal of therapy is to control and halt the infective process. Antibiotic therapy depends on the
results of blood and wound cultures. Frequently, the infection is caused by more than one pathogen. General
supportive measures (eg, hydration, diet high in vitamins and protein, correction of anemia) should be
instituted. The area affected with osteomyelitis is immobilized to decrease discomfort and to prevent
pathologic fracture of the weakened bone. Warm wet soaks for 20 minutes several times a day may be
prescribed to increase circulation.

Pharmacologic Therapy
The standard treatment for acute osteomyelitis consists of several weeks of IV antibiotic therapy. However,
as many as 3 to 6 months may be required.

As soon as the culture specimens are obtained, IV antibiotic therapy begins, based on the assumption that
infection results from a staphylococcal organism that is sensitive to a semisynthetic penicillin or
cephalosporin. The aim is to control the infection before the blood supply to the area diminishes as a result
of thrombosis. Around-the-clock dosing is necessary to achieve a sustained high therapeutic blood level of
the antibiotic. An antibiotic to which the causative organism is sensitive is prescribed after results of the
culture and sensitivity studies are known. IV antibiotic therapy continues for 3 to 6 weeks. After the
infection appears to be controlled, the antibiotic may be administered orally for up to 3 months. To enhance
absorption of the orally administered medication, antibiotics should not be administered with food.

Surgical Management
If the patient does not respond to antibiotic therapy, the infected bone is surgically exposed, the purulent
and necrotic material is removed, and the area is irrigated with sterile saline solution. Antibiotic
impregnated beads may be placed in the wound to directly deliver antibiotics to the site of the infection or
simply for direct application of antibiotics for 2 to 4 weeks. IV antibiotic therapy is continued. The beads
are an adjunct to debridement and oral and IV antibiotics for deep infections.

In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical dbridement. A sequestrectomy

(removal of enough involucrum to enable the surgeon to remove the sequestrum) is performed. In many
cases, sufficient bone is removed to convert a deep cavity into a shallow saucer (saucerization). All dead,
infected bone and cartilage must be removed before permanent healing can occur. A closed suction
irrigation system may be used to remove debris. Wound irrigation using sterile physiologic saline solution
may be performed for 7 to 8 days. The wound is either closed tightly to obliterate the dead space or packed
and closed later by granulation or possibly by grafting. The dbrided cavity may be packed with cancellous
bone graft to stimulate healing. With a large defect, the cavity may be filled with a vascularized bone
transfer or muscle flap (in which a muscle is moved from an adjacent area with blood supply intact). These
microsurgery techniques enhance the blood supply. The improved blood supply facilitates bone healing and
eradication of the infection. These surgical procedures may be staged over time to ensure healing. Because
surgical dbridement weakens the bone, internal fixation or external supportive devices may be needed to
stabilize or support the bone to prevent pathologic fracture.

Nursing Alert: After surgery to treat Osteomyelitis, frequently check for signs of neurovascular
compromise, including the six Ps. Pain that cannot be controlled, Pressure, Paresis or Paralysis (weakness
or inability to move), Paresthesia (abnormal tingling sensation), Pallor, Pulselessness. If any of these occur,
report them immediately to the surgeon

Surgical debridement is the primary treatment for the client with chronic osteomyelitis. The periosteum is
excised and the cortex is drilled to release the pressure from accumulated pus. During this procedure,
cultures may be obtained and sent to the laboratory for analysis. The wound holes are irrigated, and the
wound is then closed. The cavity may be kept clean by inserting drainage tubes that are connected to an
irrigation and suction system.
Postoperatively, the nurse is responsible for instilling and removing dilute antibiotic solutions
through the drainage tubes.
A musculocutaneous (myocutaneous) flap is another approach used for the treatment of the dead
space caused by extensive debridement of the infected site. The procedure involves moving or rotating a
muscle and the selection of skin fed by the arteries from that muscle into the cavity created by the surgery.
A skin graft is performed later.
Nursing Care of the client undergoing surgical debridement for osteomyelitis
Preoperative Care

Discuss the impending surgery, the clients concerns regarding surgery and its risk, and what steps
will be taken if surgery is ineffective. Open discussion and active listening are important means of
gaining the clients trust and encouraging the client to express concerns about the outcome of the
surgery. Surgery is frequently performed when 36 to 48 hours of antimicrobial therapy yields no
improvement and when prolonged bacteremia and evidence of an abscess formation are present.
The periosteum is excised, allowing access to the purulent material in the infected area. If pus is
not apparent, several holes may be drilled into the bone. In some cases, irrigation tubes are inserted
and connected to an elaborate system for postoperative antimicrobial therapy.
Clients may need extensive antimicrobial treatment postoperatively if an irrigation system is
surgically implanted. Before the procedure, explain to the client that bed rest and an extended
period of treatment in the hospital are imperative. Clients who understand the events that may occur
postoperatively may be more accepting of the required restrictions.

Postoperative Care

Provide meticulous care of the dressing and/or irrigation setup. Frequently, the irringation tubes
are connected to a 3-way stopcock, which allows irrigation and drainage of the debrided area
without separating the tube from the collection device. Nurses need to be extremely cautious and
adhere to strict sterile technique.
Assess the client for manifestations of further infection. Although the client will receive
antimicrobial agents, it is important to assess the client continually for sudden spikes in
temperature, pain at the involved site, and other indications of superinfection.

Client and Family Teaching

While receiving antimicrobial agents, be sure to drink adequate amounts of fluid and eat a high-
calorie diet to minimize the risks for damage to the kidneys, yeast infection, and adverse
gastrointestinal effects.

Collaborative Care
Vigorous and prolonged IV antibiotic therapy is the treatment of choice for acute osteomyelitis, as long as
bone ischemia has not yet occurred.. In the absence of such information, broad-spectrum, empiric
antibiotics should be administered. False- Choice of antibiotic therapy should be determined by culture and
susceptibility results, if possible negative blood or biopsy cultures are common in patients who have begun
antibiotic therapy. If clinically possible, delaying antibiotics is recommended until microbial culture and
sensitivity results are available.
Cultures or a bone biopsy should be done if possible before initiating drug therapy. If antibiotic therapy is
delayed, surgical debridement and decompression are often necessary. Patients are often discharged to
home care or a skilled nursing facility with IV antibiotics delivered via a central venous catheter or
peripherally inserted central catheter. IV antibiotic therapy may be started in the hospital and continued at
home for 4 to 6 weeks or as long as 3 to 6 months. A variety of antibiotics may be prescribed depending on
the microorganism. These drugs include penicillin, nafcillin (Nafcil), neomycin, vancomycin, cephalexin
(Keflex), cefazolin (Ancef), cefoxitin (Mefoxin), gentamicin (Garamycin), and tobramycin (Nebcin).

DRUG ALERT: Gentamicin (Garamycin)

Assess patient for dehydration before starting therapy.
Ensure renal function testing is done before starting therapy, especially in older patients.
Monitor peak and trough levels for therapeutic effect and to minimize renal and inner ear toxicity.
Instruct patient to notify health care provider if any visual, hearing, or urinary problems develop.

In adults with chronic osteomyelitis, oral therapy with a fluoroquinolone (ciprofloxacin [Cipro]) for 6 to 8
weeks may be prescribed instead of IV antibiotics. Oral antibiotic therapy may also be given after acute IV
therapy is completed to ensure resolution of the infection. The patients response to drug therapy is
monitored through bone scans and ESR tests. Treatment of chronic osteomyelitis includes surgical removal
of the poorly vascularized tissue and dead bone and the extended use of antibiotics.5 Antibiotic-
impregnated polymethyl methacrylate bead chains may also be implanted at this time to help combat the
infection. After debridement of the devitalized and infected tissue, the wound may be closed and a suction
irrigation system inserted. Intermittent or constant irrigation of the affected bone with antibiotics may also
be initiated. Protection of the limb or the surgical site with casts or braces is often done. Negative-pressure
wound therapy (vacuum-assisted wound closure) may be used. Hyperbaric oxygen with 100% oxygen may
be given as an adjunct therapy in refractory cases of chronic osteomyelitis. This therapy is thought to
stimulate circulation and healing in the infected tissue. Orthopedic prosthetic devices, if a source of chronic
infection, must be removed. Muscle flaps or skin grafting provides wound coverage over the dead space
(cavity) in the bone. Bone grafts may help to restore blood flow. Amputation of the extremity may be
indicated when bone destruction is extensive and to save the patients life or to improve quality of life.

Nursing Management
HEALTH PROMOTION. The control of infections already in the body (e.g., urinary, respiratory tract, deep
pressure ulcers) is important in preventing osteomyelitis. Individuals who are especially at risk for
osteomyelitis are those who are immunocompromised, have orthopedic prosthetic devices, or have vascular
insufficiencies. Instruct these patients regarding the local and systemic manifestations of osteomyelitis.
Also make family members aware of their role in monitoring the patients health. Instruct patients to
immediately report symptoms of bone pain, fever, swelling, and restricted limb movement to the health
care provider so treatment can be started.

ACUTE INTERVENTION. Some immobilization of the affected limb (e.g., splint, traction) is usually
indicated to decrease pain. Carefully handle the involved limb and avoid excessive manipulation, which
increases pain and may cause a pathologic fracture. The affected part may be immobilized with a splint to
decrease pain and muscle spasm. The nurse monitors the neurovascular status of the affected extremity.
The wounds are frequently very painful, and the extremity must be handled with great care and gentleness.
Elevation reduces swelling and associated discomfort. Assess the patients pain. Minor to severe pain may
be experienced with muscle spasms. Nonsteroidal anti-inflammatory drugs (NSAIDs), opioid analgesics,
and muscle relaxants may be prescribed to provide patient comfort. Encourage nondrug approaches to pain
management (e.g., guided imagery, relaxation breathing). Treatment regimens restrict activity. The bone is
weakened by the infective process and must be protected by immobilization devices and by avoidance of
stress on the bone. The patient must understand the rationale for the activity restrictions. The joints above
and below the affected part should be gently placed through their range of motion. The nurse encourages
full participation in ADLs within the physical limitations to promote general well-being.

Dressings are used to absorb the exudate from draining wounds and to debride devitalized tissue from the
wound site. Types of dressings include dry, sterile dressings; dressings saturated in saline or antibiotic
solution; and wet-to-dry dressings. Handle soiled dressings carefully to prevent cross contamination of the
wound or spread of the infection to other patients. Sterile technique is essential when changing the dressing.
The patient is frequently on bed rest in the early stages of the acute infection. Good body alignment and
frequent position changes prevent complications associated with immobility and promote comfort. Flexion
contracture of the lower extremity is a common complication of osteomyelitis because the patient frequently
positions the affected extremity in a flexed position to promote comfort. Footdrop can develop quickly if
the foot is not correctly supported in a neutral position by a splint or if a splint applies excessive pressure,
which can injure the peroneal nerve.

Footdrop is a deformity in which the foot is plantar flexed (the ankle bends in the direction of the sole of
the foot). If the condition continues without correction, the patient will not be able to hold the foot in a
normal position and will be able to walk only on his or her toes, without touching the ground with the heel
of the foot. The deformity is caused by contracture of both the gastrocnemius and soleus muscles. Damage
to the peroneal nerve or loss of flexibility of the Achilles tendon may result in footdrop.

NURSING ALERT Prolonged bed rest, lack of exercise, incorrect positioning in bed, and the weight of
bedding that forces the toes into plantar flexion are factors that contribute to footdrop.

Teach the patient the potential adverse and toxic reactions associated with prolonged and high-dose
antibiotic therapy (e.g., tobramycin, neomycin). These reactions include hearing deficit, nephrotoxicity,
and neurotoxicity. With cephalosporins (e.g., cefazolin) these reactions include hives, severe or watery
diarrhea, blood in stools, and throat or mouth sores. Tendon rupture (especially the Achilles tendon) can
occur with use of the fluoroquinolones (e.g., ciprofloxacin, levofloxacin [Levaquin]). Peak and trough
blood levels of most antibiotics should be monitored to avoid adverse effects. Lengthy antibiotic therapy
can also result in an overgrowth of Candida albicans and Clostridium difficile in the genitourinary and
gastrointestinal (GI) tract, especially in immunosuppressed and older patients. Instruct the patient to report
any changes in the oral cavity such as whitish yellow, curdlike lesions or changes in the genitourinary cavity
such as any perianal itching or diarrhea. The patient, caregiver, and family may be anxious and discouraged
because of the serious nature of osteomyelitis, the uncertainty of the outcome, and the cost and lengthy
course of treatment. Continued psychologic and emotional support is an integral part of nursing
management.
 STATISTICS
LOCAL STATISTICS
Statistics of Osteomyelitis cases in the year of 2014 at CVMC:

70 -
2014 1-4 5-9 10-14 15-19 20-44 45-64 65-69
above
TOTA
M F M F M F M F M F M F M F M F
L
JANUARY 1 1 2
FEBRUARY 1 1
MARCH 0
APRIL 1 1
MAY 1 1 2
JUNE 0
JULY 1 1
AUGUST 1 1
SEPTEMBER 1 1 1 1 4
OCTOBER 1 2 1 4
NOVEMBER 1 1 2 4
DECEMBER 1 1 2
TOTAL 1 1 2 1 3 0 1 0 6 3 3 0 1 0 0 0 22
2 3 3 1 9 3 1

Interpretation: The statistics show that osteomyelitis at the age group of 20-44 has a total of 9 cases followed
by at the age group of 45-64, 10-14 and 5-9 which has 3 cases each age followed by at the age group of 1-
4 which has 2 followed by 15-19 and 65-69 which has 1 each age and from age 70-above has zero case.
The total male cases are 17 and the total female cases are 5 cases. There are a total of 22 cases of
osteomyelitis in the year 2014.
Analysis: Osteomyelitis is more common in men than in women and most common at the age of 20-44
years old.
Statistics of Osteomyelitis cases in the year of 2015 at CVMC:
70 -
2015 1-4 5-9 10-14 15-19 20-44 45-64 65-69
above
M F M F M F M F M F M F M F M F TOTAL
JANUARY 1 1
FEBRUARY 1 1
MARCH 2 1 3
APRIL 1 1 1 1 4
MAY 0
JUNE 1 1 2
JULY 3 1 4
AUGUST 1 1 1 1 4
SEPTEMBER 1 1
OCTOBER 1 1 2
NOVEMBER 1 1
DECEMBER 1 1 2
TOTAL 0 0 2 0 5 1 0 0 6 1 4 0 2 1 3 0 25
2 6 7 4 3 3
Interpretation: The statistics show that osteomyelitis at the age group of 20-44 has a total of 7 cases followed
by at the age group of 10-14 which has 6 cases followed by at the age group of 45-65 which has 4 cases
followed by 65-69 and 70-above which has 3 cases each age followed by 5-9 which has 2 cases and from
age 1-4 and 15-19 has a zero case. The total male cases are 22 and the total female cases are 3. There are
a total of 25 cases of osteomyelitis in the year 2015.
Analysis: Osteomyelitis is more common in men than in women and most common at the age group of 20-
44 years old.

Statistics of Osteomyelitis cases in the year of 2016 at CVMC:

70 -
2016 1-4 5-9 10-14 15-19 20-44 45-64 65-69
above
M F M F M F M F M F M F M F M F TOTAL
JANUARY 1 1 2
FEBRUARY 1 1
MARCH 0
APRIL 2 1 3
MAY 1 1
JUNE 1 1 1 1 4
JULY 1 1
AUGUST 0
SEPTEMBER 1 1 2
OCTOBER 2 1 1 4
NOVEMBER 1 1 1 3
DECEMBER 1 1
TOTAL 2 0 1 1 2 0 4 1 5 0 2 0 2 1 1 0 22
2 2 2 5 5 2 3 1

Interpretation: The statistics show that osteomyelitis at the age of 15-19 and 20-44 has a total of 5 cases
each followed by at the age group of 65-69 which has 3 cases followed by at the age group of 1-4, 5-9, 10-
14 and 45-64 which has 2 cases of each age followed by at the group age of 70-above which has 1 case.
The total male cases are 19 the total female cases are 3 . There are a total of 22 cases of osteomyelitis in
the year 2016.
Analysis: Osteomyelitis is more common in men than in women and most common at the age of 20-44
years old and 15-19 years old.
Number of Patient and Age group

10
9
9

8
7
7
NO. OF PATIENTS

6
6
5 5
5
4
4
3 3 3 3 3 3
3
2 2 2 2 2 2
2
1 1 1
1
0 0 0
0
2014 2015 2016
YEAR

1-4 y/o 5-9 y/o 10-14 y/o 15-19 y/0 20-44 y/0 45-64 y/o 65-69 y/o 70 y/o & up

Interpretation: The statistics show that there are 9 cases of osteomyelitis in the age group of 20-44 years old
in the year of 2014. Also, there are 7 cases in the age group of 20-44 years old in the year of 2015 and 5
cases in the age group of 20-44 years old and 15-19 years old in the year of 2016.
Analysis: Osteomyelitis is most common at the age of 20-44 years old.

Number of Patient and Sex

25
22

20 19
NO. OF PATIENTS

15
12

10

5
5 3 3

0
2014 2015 2016
YEAR

MALE FEMALE

Interpretation: The statistics show that there 12 male cases of osteomyelitis in the year of 2014. There are
22 male cases in the year of 2015 and19 cases in the year of 2016. For the female case, there are 5 cases in
the year 2014 and both 3 cases in the year of 2015 and 2016
Analysis: Osteomyelitis is more common in men than in women