Would you still treat with course for osteomyelitis if proximal bone cultures after amputation are still positive but pathology does not demonstrate osteomyelitis?

Like many questions in Infectious Diseases, the answer is “it depends.” This includes the type of amputation (I have a lower threshold to treat after a ray amputation, whereas I am more comfortable stopping therapy after a below-knee amputation), the organism isolated (particularly when Staphylococcus aureus is involved), and the gross intra-operative appearance. I also take the surgeon’s experience and track record into account. Patient-specific factors are equally important, as I have seen rel...

No. I feel as though path trumps culture. It is common for bacteria to contaminate the clean bone margin (as they can be dragged in at the time of amputation). The pathology, however, will be pure and cannot be contaminated. Thus, if the pathology shows no osteomyelitis at the edges, I believe no further antibiotic therapy for osteomyelitis is necessary (if there is some surrounding skin or soft tissue infection, sometimes I give a short course postoperatively for that, but a full course for bon...