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Bone and Joint Infections in the Elderly

Practical Treatment Guidelines

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Abstract

Two types of haematogenous osteomyelitis that are seen in the elderly are vertebral and long bone osteomyelitis. Osteomyelitis secondary to contiguous foci of infection can occur in older adults without vascular insufficiency (secondary to pressure ulcers) or with vascular insufficiency due to diabetes mellitus or peripheral vascular disease from atherosclerosis. Most cases of osteomyelitis can be reasonably treated with adequate drainage, thorough debridement, obliteration of dead space, wound protection, and antimicrobial therapy. Patients are initially given a broad spectrum antimicrobial that is changed to specific antimicrobial therapy based on meticulous bone cultures taken at debridement surgery or from deep bone biopsies. Surgical management is often required in the treatment of osteomyelitis and includes adequate drainage, extensive debridement of all necrotic tissue, obliteration of dead spaces, stabilisation, adequate soft tissue coverage, and restoration of an effective blood supply.

Bone repair and bone mineral density may be significantly retarded and may be corrected by eliminating risk factors, supplementing the diet with calcium, bisphosphonates, and/or vitamin D, and treating with testosterone and/or estrogen when deficient. Sodium fluoride treatment and anabolic steroids may be used as alternatives.

Septic arthritis is a medical emergency, and prompt recognition and rapid and aggressive treatment are critical to ensuring a good prognosis. The treatment of septic arthritis includes appropriate antimicrobial therapy and joint drainage.

Adverse effects of prescribed antibacterials occur more often in the elderly patient than in young adults. The physician can help to minimise the incidence of adverse effects and improve outcomes by being aware of the principles of clinical pharmacology, the characteristics of specific drugs, and the special physical, psychological and social needs of older patients.

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Acknowledgements

The authors wish to thank Michael Cripps and Donna Milner Mader for manuscript review, reference research and preparation.

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Authors and Affiliations

  1. The Marine Biomedical Institute, Division of Marine Medicine, University of Texas Medical Branch, Galveston, Texas, USA

    Jon T. Mader, Mark E. Shirtliff & Jason H. Calhoun

  2. Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch, Galveston, Texas, USA

    Jon T. Mader

  3. Department of Orthopaedic Surgery, University of Texas Medical Branch, Galveston, Texas, USA

    Jon T. Mader & Jason H. Calhoun

  4. Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA

    Mark E. Shirtliff

  5. Department of Pharmacy, University of Texas Medical Branch, Galveston, Texas, USA

    Stephen Bergquist

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  1. Jon T. Mader
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  4. Jason H. Calhoun
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Correspondence to Jon T. Mader.

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Mader, J.T., Shirtliff, M.E., Bergquist, S. et al. Bone and Joint Infections in the Elderly. Drugs Aging 16, 67–80 (2000). https://doi.org/10.2165/00002512-200016010-00006

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