Osteomyelitis occurs either as a result of hematogenous seeding, contiguous spread of infection to bone from adjacent soft tissues and joints, or direct inoculation of infection into the bone as a result of trauma or surgery. Hematogenous osteomyelitis is usually monomicrobial, while osteomyelitis due to contiguous spread or direct inoculation is usually polymicrobial. Staphylococcus aureus, coagulase-negative staphylococci and aerobic gram-negative bacilli are the most common organisms; other pathogens including streptococci, enterococci, anaerobes, fungi and mycobacteria have also been implicated. Acute osteomyelitis typically presents with gradual onset of pain over several days. Local findings (tenderness, warmth, erythema and swelling) and systemic symptoms (fever, rigors) may also be present. Chronic osteomyelitis tends to occur in the setting of previous osteomyelitis and presents with recurrent pain, erythema
or swelling, sometimes in association with a draining sinus tract. Treatment of osteomyelitis often requires both surgical debridement of necrotic material and antimicrobial therapy for eradication of infection. The optimal duration of antibiotic therapy is not certain; but continuing parenteral antimicrobial therapy at least six weeks from the last debridement.
Maggot therapy is an effective and environmentally friendly treatment of complicated necrotic wounds that are resistant to conventional treatment and should also be considered in earlier stages of treatment. The history of maggot therapy, and the mechanisms by which it works, is discussed.