Osteomyelitis is infection of the bone or marrow caused by bacteria or mycobacteria. It is difficult to treat due to the relative paucity of blood vessels in bone and the fact that many antimicrobials do not penetrate bone well. Refractory osteomyelitis is a chronic osteomyelitis that does not respond or that returns after appropriate treatment. Patients presenting with osteomyelitis to the spine, skull, or sternum have a high risk for morbidity and mortality from this infection. The standard treatment for chronic and refractory osteomyelitis include surgical debridement and culture directed antibiotics. Hyperbaric oxygen treatments can be considered an American Heart Association (AHA) Class II recommendation for the treatment of chronic, refractory osteomyelitis. In patients with Wagner grade 3 or 4 diabetic foot ulcers (DFU) with osteomyelitis, adjunctive hyperbaric oxygen therapy is an AHA Class I intervention. Recent studies have postulated that up to 20% of patients presenting to Wound Care Centers for treatment of Wagner 3 Diabetic foot ulcers already have Osteomyelitis. Infection in bone is one of the causes of a nonhealing wound, and should be suspected and tested for sooner rather than later when a patient presents with a chronic, nonhealing wound.
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