Complications
In general, all antibiotics carry a risk of minor complications such as diarrhea and rash, while some carry risks of hepatotoxicity. Some have other adverse 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 complete 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).
Free flap reconstruction may fail. This usually occurs early in the first 48 hours following surgery. An attempt at salvaging the flap can be made if recognized early. Flap failure rates are about 5% in specialist centers with high volumes of infection cases.
Amputation has traditionally been a feared complication of severe chronic osteomyelitis; however, the need for this intervention is becoming much less common for long-bone osteomyelitis. Occasionally prosthetic joint infections and rarely long-bone fracture nonunions result in a requirement for amputation.
In skeletally immature patients, osteomyelitis can result in growth disturbance by causing premature physeal closure. This can result in short limbs or angular deformity if only partial physeal arrest occurs.
Can develop either as a result of the infection or of its treatment. Any surgery should try to preserve joint range of movement to minimize this risk. This is a recognized complication of addressing limb shortening through lengthening surgery.
This is the most serious complication of vertebral osteomyelitis, which is the predominant form of hematogenous osteomyelitis in adults. At first presentation, urgent draining of pus should be considered if there is an associated epidural or paravertebral abscess. In patients with neurologic compromise with or without impending sepsis or hemodynamic instability, immediate surgical intervention should be initiated alongside empiric antimicrobial therapy.[13] 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 stabilize 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, patients should be monitored for line infections, thrombus, and other complications from indwelling of catheters.[141]
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