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. 2018 Apr 10;18(1):166.
doi: 10.1186/s12879-018-3076-y.

Pressure ulcer-related pelvic osteomyelitis: evaluation of a two-stage surgical strategy (debridement, negative pressure therapy and flap coverage) with prolonged antimicrobial therapy

Johan Andrianasolo  1   2   3 , Tristan Ferry  1   2   4 , Fabien Boucher  2   5 , Joseph Chateau  2   5 , Hristo Shipkov  2   5 , Fatiha Daoud  1   2 , Evelyne Braun  1   2 , Claire Triffault-Fillit  1   2 , Thomas Perpoint  1   2 , Frédéric Laurent  2   4   6 , Alain-Ali Mojallal  2   5 , Christian Chidiac  1   2   4 , Florent Valour  7   8   9   10 ; Lyon BJI study group
Collaborators, Affiliations

Pressure ulcer-related pelvic osteomyelitis: evaluation of a two-stage surgical strategy (debridement, negative pressure therapy and flap coverage) with prolonged antimicrobial therapy

Johan Andrianasolo et al. BMC Infect Dis. .

Abstract

Background: A two-stage surgical strategy (debridement-negative pressure therapy (NPT) and flap coverage) with prolonged antimicrobial therapy is usually proposed in pressure ulcer-related pelvic osteomyelitis but has not been widely evaluated.

Methods: Adult patients with pressure ulcer-related pelvic osteomyelitis treated by a two-stage surgical strategy were included in a retrospective cohort study. Determinants of superinfection (i.e., additional microbiological findings at reconstruction) and treatment failure were assessed using binary logistic regression and Kaplan-Meier curve analysis.

Results: Sixty-four pressure ulcer-related pelvic osteomyelitis in 61 patients (age, 47 (IQR, 36-63)) were included. Osteomyelitis was mostly polymicrobial (73%), with a predominance of S. aureus (47%), Enterobacteriaceae spp. (44%) and anaerobes (44%). Flap coverage was performed after 7 (IQR, 5-10) weeks of NPT, with 43 (68%) positive bone samples among which 39 (91%) were superinfections, associated with a high ASA score (OR, 5.8; p = 0.022). An increased prevalence of coagulase negative staphylococci (p = 0.017) and Candida spp. (p = 0.003) was observed at time of flap coverage. An ESBL Enterobacteriaceae spp. was found in 5 (12%) patients, associated with fluoroquinolone consumption (OR, 32.4; p = 0.005). Treatment duration was as 20 (IQR, 14-27) weeks, including 11 (IQR, 8-15) after reconstruction. After a follow-up of 54 (IQR, 27-102) weeks, 15 (23%) failures were observed, associated with previous pressure ulcer (OR, 5.7; p = 0.025) and Actinomyces spp. infection (OR, 9.5; p = 0.027).

Conclusions: Pressure ulcer-related pelvic osteomyelitis is a difficult-to-treat clinical condition, generating an important consumption of broad-spectrum antibiotics. The lack of correlation between outcome and the debridement-to-reconstruction interval argue for a short sequence to limit the total duration of treatment.

Trial registration: ClinicalTrials.gov NCT03010293.

Keywords: Antimicrobial therapy; Bacteriology; Chronic osteomyelitis; Debridement; Flap coverage; Negative pressure therapy; Pressure ulcer.

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Conflict of interest statement

Ethics approval and consent to participate

The study (ClinicalTrial.gov registration number NCT03010293) received the approval of the French South-East Ethics Committee (reference number QH20–2014). In accordance with French legislation, written informed consent was not required for any part of the study.

Competing interests

There is no conflict of interest, for all authors.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Comparison of microbiological findings among bone biopsies performed at debridement and flap reconstruction
Fig. 2
Fig. 2
Kaplan Meier curves for cumulative probability of treatment failure-free survival according to the two main risk factors highlighted in multivariate analysis, i.e., an history of previous ulcer at the same site (a) and Actinomyces spp. infection (b)
See this image and copyright information in PMC

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