Aim: To assess trends in acute pyogenic osteomyelitis (OM) over the last six years in the Top End catchment area of the Royal Darwin Hospital (RDH).

Methods: One hundred and seventy-five medical records were assessed to investigate the trends in acute pyogenic OM. The outcome was determined on the basis of resolution of symptoms and signs and lack of recurrence/ representation at RDH. The follow-up period for subjects varied between six years and six months and depended on the time of presentation within the six-year span of the study.

Results: One hundred and one cases of acute pyogenic OM were found to meet the inclusion criteria. An average yearly incidence of 1.3 +/−0.7(CI95%) cases per 1000 cases was noted. Of these, 79.2% of cases were male, 70.3% in the age group 0–30 years and 67.3% ATSI. The most common sites affected were the lower extremities (62.3%) and the hands (32.6%). The average delay in presentation after the onset of symptoms was 30.5 days +/−12.8 days (CI 95%). A microbe was identified in only 50% of cases. Staphylococcus aureas was the causative organism in 83.6% of cases. All patients were treated with antibiotics or surgery. The average time for treatment with IV antibiotics was 9.8 days +/− 1.5 (95% CI). The average time for oral antibiotic treatment was 5.4 weeks +/− 0.7 (95%CI). 52.4.% of patients required surgery, with 16% requiring more than one operation and 10.2% requiring terminalisation or amputation of digits. There was a recurrence rate of 3.9%.

Conclusions: OM in the Northern Territory occurs predominantly in males aged less than 30 years, and most commonly in the ATSI population. The most common organism is Staphylococcus aureas. Intravenous therapy for 10 days and oral therapy for six weeks has been shown to be adequate, giving a recurrence rate of 3.9%.