Haematogenous osteomyelitis is difficult to prevent
because bacteraemia is usually unpredictable. The
exception is nosocomial bacteraemia, particularly that
due to infected intravascular access devices. Peripheral
cannulae should not be left in for more than 3 days and
central venous catheters should be dressed and nursed
appropriately. Perioperative antibiotic prophylaxis has
been shown to decrease the incidence of osteomyelitis
and septic arthritis in prosthetic joint insertion and in
the operative management of compound fractures. In
both cases, prophylactic antibiotics are only necessary
for a maximum of 12–24 h, and there is no benefit
continuing them for longer.56–58
Patients with diabetes and peripheral neuropathy
should have regular podiatry assessment and seek urgent
medical assessment if they develop a foot ulcer. Ulcers
should be evaluated for the presence of osteomyelitis,
and if this is not thought to be likely, they should be
treated as a soft tissue infection with antibiotics and local
debridement.