Refractory Osteomyelitis

Refractory osteomyelitis is a bone infection which has not responded to appropriate treatment. Hyperbaric oxygen increases the oxygen concentration in infected tissues, including bone, and kills or inhibits the growth of organisms which prefer low oxygen concentrations. These effects occur through the oxygen-induced production of toxic radicals or through an indirect effect medicated through the white blood cells (polymorphonuclear leukocytes).

Conversely, hyperbaric oxygen has no direct effect on organisms which prefer high oxygen concentrations (aerobes). In fact, hyperbaric oxygen conditions may induce aerobic organisms to produce increased concentrations of enzymes protective against oxygen radicals (e.g. superoxide dismutase). When hyperbaric oxygen increases the oxygen tension in infected tissue, however, the oxygen-dependent killing mechanisms of the polymorphonuclear leukocyte are provided sufficient oxygen to function. Thus, hyperbaric oxygen treatment provides the necessary oxygen for the killing of aerobic organisms by the polymorphonuclear leukocyte.

Hyperbaric oxygen also increases the efficacy of certain antibiotics (aminoglycosides, vancomycin, quinolones and certain sulfonamides) in killing bacteria. Hyperbaric oxygen provides adequate oxygen for fibroblast activity, cells which promote healing in oxygen deprived tissues. Finally hyperbaric oxygen prevents polymorphonuclear leukocytes from adhering to damaged blood vessel linings. This decreases the degree of inflammation which may accompany the surgical treatment of refractory osteomyelitis.

Hyperbaric oxygen is used clinically for the treatment of refractory osteomyelitis as noted above. Hyperbaric oxygen is adjunctive therapy and is used with appropriate antibiotics, surgery and nutrition. There are clinical studies supporting the use of hyperbaric oxygen for the treatment of refractory osteomyelitis.


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  2. Mader JT, Brown GL, Guckian JC, Wells CH, Reinarz JA. A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits. J Infect Dis 1980;142:915-922.
  3. Davis JC, Heckman JD, DeLee JC, Buckwold FJ. Chronic non-hematogenous osteomyelitis treated with adjuvant hyperbaric oxygen. J Bone Joint Surg 1986;68A:1210-1217.
  4. Mader JT, Shirtliff ME, Calhoun JH. The Use of Hyperbaric Oxygen in the Treatment of Osteomyelitis. In: Hyperbaric Medicine Practice. Best Publishing Co. Flagstaff, Arizona. 1999;603-616.
  5. Mader JT, Calhoun JH. Osteomyelitis. In: Principles and Practice of Infectious Diseases. GL Mandell, RG Douglas, JE Bennett Jr. (Eds). Churchill Livingstone, New York, NY: 5th Edition. 1999;1039-1051.

Center for Hyperbaric Medicine