Substantially what is bone infection? It’s a bacterial colonization of a tissue which presents scarce or no humoral immunity as it has lost vascularity and has become necrotic. If vascularity is lost, the tissue becomes like a foreign body which is conducive to a surrounding inflammatory granuloma which aims at isolating the necrotic area. However, the microbes remain in situ and proliferate, being essentially isolated from the natural defense system. Any specific antibiotic, which destroys the microbes in vitro where there is ample contact between pathogen and drug, cannot reach the pathogen in a way to be effective in vivo, as the vascularity which is the delivery vehicle does not extend into the necrotic bone and therefore stops in the inflammatory area without reaching the necrotic bone. In the years past, and unfortunately, to this date, there was, and still remains, a school of thought (purely philosophical in my opinion), which considers bone infection in the same line of any other localized infection where vascularity is maintained and the possibility that it can be reached by drugs and humoral defensive is real.
Citation: Catagni MA (2014) Bone Infection: Therapeutical Pearls Based on Evidence of 458 Cases on Infected Pseudoarthrosis and Other Cases of Bone Infection in the Department of Orthopedics of Lecco from 1981 to 2011. J Infect Dis Ther 2:183. doi: 10.4172/2332-0877.1000183