Complications
In general, all antibiotics carry a risk of minor complications such as diarrhoea and rash, while some carry risks of hepatotoxicity. Some have adverse 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.
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.
Can develop either as a result of the infection or of 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.[131] Surgical intervention is required for progressive neurological deficits, progressive deformity, and spinal instability with or without pain despite adequate antimicrobial therapy.[10] Surgical debridement with or without stabilisation is needed for persistent or recurrent bloodstream infection (without alternative source) or worsening pain despite appropriate medical therapy.[10][132]
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.[133]
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