Osteomyelitis (OM)



Local findings (tenderness, warmth, erythema, and swelling) and systemic symptoms (fever, rigors); presents within a week of symptom onset

Symptoms as above; sometimes in association with a draining sinus tract; fever is usually absent

  • If positive in diabetic foot ulcers increases the pre-test probably for OM
  • C-reactive protein (CRP)
  • May be elevated
  • Can be used to monitor treatment response over time


Bone Biopsy Culture, if available, is important to determine the causative pathogen

  • Hold antibiotics until biopsy obtained (unless patient systemically unwell or associated soft tissue infection)
  • For all patients
  • Can identify causative organism of hematogenous OM
  • Cultures should not be taken from superficial ulcers or sinus tracts
  • Will likely just reflect colonization
  • If imaging demonstrates, aspirate for culture


  • For destruction, erosions, deformity
  • Changes will be seen 7+ days after infection starts (not before)
  • Even if appropriate therapy bone changes can evolve & persist; this does not indicate ineffective therapy.
  • For destruction, erosions, and soft tissue or bone abscess
  • Bony changes will be seen 7+ days after infection starts (not before)
  • Can demonstrate bone marrow edema consistent with early OM before bony changes are evident
  • Can identify OM early (in first 7 days)
  • Repeat imaging is not helpful to determine clinical response