Osteomyelitis laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A., Seyedmahdi Pahlavani, M.D. [2]

Overview

Laboratory findings in osteomyelitis include increased acute phase reactants (ESR and CRP) levels and leukocytosis.^[1] Blood cultures should be performed in all suspected cases. Bone probing and direct sampling is a reliable method, especially in diabetic ulcers which are contaminated with many flora.

Laboratory Findings

Microbiology and histopathology are essential for diagnosis and determining treatment of osteomyelitis.

Histopathology of bone biopsy samples typically provides the most accurate diagnosis.
Blood cultures are typically more reliable for hematogenous or vertebral osteomyelitis.
Samples obtained from swabbing sinus tracts should not be used as the isolate may be contaminated with non-pathogenic microorganisms.

Isolation techniques to determine the causative agent include:

Blood cultures
Bone biopsy (which is then cultured)

Laboratory tests to determine infection include:^[2]^[3]

Complete blood count (CBC)
C-reactive protein (CRP)
Erythrocyte sedimentation rate (ESR)
Note: white blood cell count (WBC) is typically normal and therefore not reliable

References

↑ Pääkkönen M, Kallio MJ, Kallio PE, Peltola H (2010). “Sensitivity of erythrocyte sedimentation rate and C-reactive protein in childhood bone and joint infections”. Clin. Orthop. Relat. Res. 468 (3): 861–6. doi:10.1007/s11999-009-0936-1. PMC 2816763. PMID 19533263.
↑ Unkila-Kallio L, Kallio MJ, Eskola J, Peltola H (1994). “Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children”. Pediatrics. 93 (1): 59–62. PMID 8265325.
↑ Cavanagh PR, Lipsky BA, Bradbury AW, Botek G (2005). “Treatment for diabetic foot ulcers”. Lancet. 366 (9498): 1725–35. doi:10.1016/S0140-6736(05)67699-4. PMID 16291067.

[pmid19533263-1] Pääkkönen M, Kallio MJ, Kallio PE, Peltola H (2010). “Sensitivity of erythrocyte sedimentation rate and C-reactive protein in childhood bone and joint infections”. Clin. Orthop. Relat. Res. 468 (3): 861–6. doi:10.1007/s11999-009-0936-1. PMC 2816763. PMID 19533263.

[pmid8265325-2] Unkila-Kallio L, Kallio MJ, Eskola J, Peltola H (1994). “Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children”. Pediatrics. 93 (1): 59–62. PMID 8265325.

[pmid16291067-3] Cavanagh PR, Lipsky BA, Bradbury AW, Botek G (2005). “Treatment for diabetic foot ulcers”. Lancet. 366 (9498): 1725–35. doi:10.1016/S0140-6736(05)67699-4. PMID 16291067.

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