Infections involving bones may be a consequence of hematogenous spread or by direct inoculation following trauma or surgical intervention (secondary osteomyelitis). Hematogenous bacterial osteomyelitis results from a source elsewhere in the body and has decreased in incidence over the past 25 years. The typical case involves the metaphyseal portion of long bones in children aged 15 years or below. Staphylococcus aureus is the most common organism cultured; however,
Hemophilus influenza may be present in children aged less than three years (7). Other bacteria such as Group B streptococcus and coliforms may be seen in neonates. Staphylococcus epidermidis is another pathogen sometimes cultured and may follow surgical procedures or invasive techniques such as an intravenous catheter placement. Vertebral body involvement, especially in older patients with genitourinary tract infection (gram-negative rods), can occur via Batson's venous plexus. Infections involving the small bones of the hands and feet usually manifest in elderly diabetics (8).
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