Osteomyelitis: options for diagnosis and management.

The bacterial aetiology of osteomyelitis is best determined by bone biopsy under radiographic control. While Staphylococcus aureus is still the most common cause of osteomyelitis, Gram-negative bacteria occur more frequently than they did in the past. The prognosis of antibiotic treatment is made worse by chronic infection and by underlying conditions, such as diabetes mellitus or peripheral vascular disease. Treatment for six weeks with single broad-spectrum antimicrobial agents can give success rates similar to those obtained with combination therapy, including aminoglycosides, and with less toxicity. Newer diagnostic methods (radionuclide scans and radiographic techniques) and treatment options (antibiotic-containing acrylic beads and microvascular grafts) may offer improved management if used discriminatingly.