Emergency Department and Inpatient Clinical Pathway for Evaluation/Treatment of Osteomyelitis
  • Initial labs and imaging
    • CBC with Diff, CRP, ESR, Blood Culture
    • Consider CK if myositis possible
    • Plain X-ray of affected area
Osteomyelitis Less Likely
Osteomyelitis Suspected
MRI not consistent
with osteomyelitis
MRI consistent
with osteomyelitis
Alternative Diagnosis
  • Treat, admit as clinically appropriate
  • Primary medical doctor follow up if symptoms do not improve
Good Treatment Response
Inadequate Treatment Response after 48-72 hours of antibiotics
  • Continued fever, pain
  • No improvement in inflammatory
  • Repeatedly positive blood cultures
  • Discuss changing empiric antibiotics with infectious diseases
  • Orthopedic consultation
Inadequate Treatment Response

Discuss utility of repeat imaging and biopsy/surgical intervention with infectious diseases and orthopedics

Posted: October 2020
Revised: September 2021
Authors: M. Dunn, MD; E. Kitt, MD; M. Hayes, PharmD; T. Joerger, MD; J. Nguyen, MD; J. Beus, MD; J. Burns, MD; B. Coburn, MD; K. Downes, MD; V. Fairchild, MD; J. Anari, MD; A. Arkader, MD; S. Goyal, MD; R. Rempell, MD; D. Spiegel, MD; A. S. Srinivasan, MD; S. K. Swami, MD; S. Vatsky, MD; R. Harris, MD