Osteomyelitis Diagnosis and Treatment

Diagnostic Approach

The Infectious Diseases Society of America recommends obtaining plain radiographs initially, looking for periosteal reaction, focal bone lucency, or frank bone destruction, and proceeding with imaging regardless of normal laboratory values 2, 3
MRI is the definitive imaging study, and a negative MRI effectively rules out osteomyelitis, as suggested by the Radiology society 2, 4, 3
The American Diabetes Association suggests performing a probe-to-bone test if an open wound is present, as a positive test with clinical infection is highly suggestive of osteomyelitis 5, 3

The American College of Radiology recommends bone biopsy for definitive diagnosis when diagnosis is uncertain, soft tissue cultures are inconclusive, or infection fails to respond to empirical therapy 4, 3, 6
The Infectious Diseases Society of America suggests initiating empiric antibiotic therapy based on clinical and imaging findings, not laboratory values, with parenteral therapy preferred for moderate to severe infections initially 2, 6
The Journal of the American College of Radiology recommends considering surgical debridement if subperiosteal collections, bone necrosis, or failure to respond to antibiotics occurs 7, 3