Staphylococcal Osteomyelitis: Disease Progression, Treatment Challenges, and Future Directions

Abstract

Osteomyelitis is an inflammatory bone disease that is caused by an infecting microorganism and leads to progressive bone destruction and loss. The most common causative species are the usually commensal staphylococci, with Staphylococcus aureus and Staphylococcus epidermidis responsible for the majority of cases. Staphylococcal infections are becoming an increasing global concern, partially due to the resistance mechanisms developed by staphylococci to evade the host immune system and antibiotic treatment. In addition to the ability of staphylococci to withstand treatment, surgical intervention in an effort to remove necrotic and infected bone further exacerbates patient impairment. Despite the advances in current health care, osteomyelitis is now a major clinical challenge, with recurrent and persistent infections occurring in approximately 40% of patients. This review aims to provide information about staphylococcus-induced bone infection, covering the clinical presentation and diagnosis of osteomyelitis, pathophysiology and complications of osteomyelitis, and future avenues that are being explored to treat osteomyelitis.

Keywords: Staphylococcus aureus; Staphylococcus epidermidis; antibiotic; joint infections; nonantibiotic; osteomyelitis.

FIG 1

Progression of osteomyelitis. An abscess develops from a localized infection that constricts the blood flow to the area (A), resulting in an avascular region of necrotic bone tissue called the sequestrum (B), followed by development of new bone surrounding the sequestrum, termed the involucrum, which may also have a sinus tract through which purulence can escape (C).

FIG 2

Staphylococcus aureus and Staphylococcus epidermidis cell surface proteins, known as microbial surface components recognizing adhesive matrix molecules (MSCRAMMs), that are involved in interacting with bone and the bone ECM.

FIG 3

Stages of biofilm development (214). The first stage of biofilm formation in bone is attachment. Once attached, the bacteria begin to accumulate and produce a sticky matrix, which is the initial biofilm. This accumulation results in the formation of biofilm microcolonies and development of mature biofilm. The biofilm may then finally break down and release the bacteria from within, causing dissemination throughout the host.