Complications
In general, all antibiotics carry a risk of minor complications such as diarrhoea and rash, while some carry risks of hepatotoxicity. Some have other side effects and many have interactions with other medications. All interactions should be carefully checked before commencing medications. Patient reaction to an antibiotic should be closely monitored and antibiotic selection changed as necessary. Bloods should be checked at least weekly while on intravenous antibiotic therapy to monitor for adverse effects. This should include full blood count, electrolytes, and liver function tests in addition to inflammatory markers (e.g., C-reactive protein). Some drugs may need extra monitoring (e.g., creatinine kinase with daptomycin). Long-term antibiotics may increase antimicrobial resistance and the emergence of multidrug-resistant organisms.
Free flap reconstruction may fail. This usually occurs early in the first 48 hours following surgery. Flap salvage can be attempted if recognised early. Flap failure rates are about 5% in specialist centres with high volumes of infection cases.
The need for amputation is becoming much less common for long-bone osteomyelitis. Occasionally prosthetic joint infections and rarely long-bone fracture non-unions require amputation.
In a skeletally immature patient, osteomyelitis can cause premature physeal closure, resulting in short limbs or angular deformity if only partial physeal arrest occurs.
Can develop either as a result of the infection or its treatment. Any surgery should try to preserve joint range of movement to minimise this risk. This is a recognised complication of addressing limb shortening through lengthening surgery.
This is the most serious complication of vertebral osteomyelitis, which is the predominant form of haematogenous osteomyelitis in adults. At first presentation, urgent draining of pus should be considered if there is an associated epidural or paravertebral abscess. This is an emergency if there are neurological symptoms/signs. In vertebral osteomyelitis, most patients, but not all, have gradual improvement in back pain after therapy is begun, and pain disappears if there is adequate bone fusion. In some cases further surgical intervention is required to stabilise the spine or reduce pain.
Outpatient antimicrobial therapy has been greatly enhanced by the use of peripherally inserted central catheters for intravenous therapy. While this is generally safe and cost-effective, a patient should be monitored for line infections, thrombus, and other complications from indwelling of catheters.[106]
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