title: The management of osteomyelitis in the adult.
abstract: OBJECTIVE
  Osteomyelitis (OM) is considered one of the most challenging medical conditions an orthopaedic surgeon has to face. Much debate is present concerning diagnosis and treatment, especially about differences between acute and chronic forms of the condition. The main aim of the present work is to show the key points where research should be implemented.
  
  
  METHODS
  Online database were searched to find evidence about the clinical management of osteomyelitis. Clinical randomized trials, case series, prospective cohort studies reporting on diagnosis and treatment of acute and chronic osteomyelitis were taken into consideration. Cadaveric studies, laboratory studies, case reports, review articles and meta-analyses were excluded. Furthermore, studies concerning implant related OM were excluded. Studies in English, Spanish and French were considered in this process of inclusion. The cohorts of all the included studies were composed of adult patients.
  
  
  RESULTS
  The main growpoints concerning OM are the identification of a correct laboratory test array to allow a prompt diagnosis and provide a sensitive and specific detection of the bacterial species involved, along with antibiotic drug resistance; optimal imaging techniques, according to the phase of the infection, have to be performed, to avoid unnecessary medical expenses; the identification of a suitable compromise between intravenous and oral drugs administration. A flow chart is proposed for optimal clinical management of this pathology.
  
  
  CONCLUSIONS
  More work should be carried out to clarify the main issues concerning the clinical management of osteomyelitis in adult patients.
authors.affiliation: Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, United Kingdom; Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84081 Baronissi, Salerno, Italy. Electronic address: n.maffulli@qmul.ac.uk.
authors.forename: N
authors.initials: N
authors.lastname: Maffulli
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, Rome, Italy. Electronic address: r.papalia@unicampus.it.
authors.forename: R
authors.initials: R
authors.lastname: Papalia
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Zampogna
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, Rome, Italy. Electronic address: guglielmo.torre@alcampus.it.
authors.forename: G
authors.initials: G
authors.lastname: Torre
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Albo
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, Rome, Italy. Electronic address: denaro@unicampus.it.
authors.forename: V
authors.initials: V
authors.lastname: Denaro
mesh_terms: D000328:Adult; D006801:Humans; D010019:Osteomyelitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
keywords: Bone infection; Clinical management; Evidence-based medicine; Osteomyelitis