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. 2018 Jun;31(3):217-225.
Epub 2018 May 11.

Bacterial osteomyelitis: microbiological, clinical, therapeutic, and evolutive characteristics of 344 episodes

E García Del Pozo, J Collazos, J A Cartón, D Camporro, V Asensi  1
Affiliations

Bacterial osteomyelitis: microbiological, clinical, therapeutic, and evolutive characteristics of 344 episodes

E García Del Pozo et al. Rev Esp Quimioter. 2018 Jun.

Abstract
in English, Spanish

Objective: Osteomyelitis is a difficult-to-cure infection, with high relapse rate despite adequate therapy. Large published osteomyelitis series in adults are rare.

Methods: A total of 344 adult osteomyelitis patients were studied and followed > 12 months after hospital discharge. Demographic, microbiological, clinical, therapeutic and outcome data were analyzed.

Results: Mean age was 52.5 ± 18.3 years and 233 (67.7%) were male. Main osteomyelitis types were post-surgical (31.1%), post-traumatic (26.2%) and hematogenous (23%). Tibia (24.1%) and femur (21.8%), and methicillin-susceptible S. aureus (29.6%) were the most commonly involved bone and bacteria, respectively. Median follow-up was 12.0 (IQR 0-48) months. Inflammatory markers were increased in 73.6%. Overall, patients were treated by IV and oral routes with one (IV: 44.5%, oral: 26.7%), two (IV: 30.1%, oral: 21.8%) or ≥ 2 (IV: 15.2%, oral: 6.1%) antibiotics. Median duration on IV/oral antimicrobials was 28.0 (IQR 24-28) and 19.5 (IQR 4-56) days, respectively. Anti-staphylococcal β-lactams cloxacillin/cefazolin (19.2%) and ciprofloxacin (5.5%) were the most frequently used IV and orally, respectively. Overall 234 (68.0%) underwent surgery, 113 (32.8%) debridement, 97 (27.4%) debridement + muscle flap and 24 (7%) amputation. At the end of follow-up 208 patients (60.6%) did not have relapsed. Operated patients had significantly less relapses (p<0.0001). A total of 23 (6.7%) died, 11 (3.2%) by infectious complications and 48 (14%) were lost in the follow-up.

Conclusions: Osteomyelitis is due to different causes complicating its therapy. Risk factors or causal microorganism could influence its treatment and outcome. Aggressive surgery along with adequate antimicrobial therapy are mandatory for cure.

Introducción: La osteomielitis es una infección difícil de curar, de etiología múltiple y con una alta tasa de recidivas a pesar del empleo de tratamientos combinados médicos y quirúrgicos. Hay muy pocas series amplias de aspectos generales de la osteomielitis publicadas hasta ahora.

Material y métodos: Se siguieron 344 pacientes adultos diagnosticados de osteomielitis durante > 1 año tras el alta médica. Se recogieron y analizaron sus características demográficas, microbiológicas, clínicas, terapéuticas y evolutivas.

Resultados: La edad media fue de 52,5 ± 18.3 años y 233 (67,7%) eran hombres. Los principales tipos de osteomielitis fueron post-quirúrgica (31,1%), post-traumática (26,2%) y hematógena (23%). Tibia (24,1%) y fémur (21,8%) y Staphylococcus aureus sensible a meticilina (29,6%) fueron los huesos y bacteria implicados con mayor frecuencia, respectivamente. El tiempo medio de seguimiento fue de 12 (RIQ 0-48) meses. Los reactantes de fase aguda estaban elevados en 73,6%. Los pacientes fueron tratados con uno (44,5% y 26,7%), dos (30,1% y 21,8%) o más de dos antibióticos (15,2% y 6,1%) por vía IV y oral, respectivamente. La duración media de la terapia antimicrobiana IV/oral fue de 28,0 (RIQ 24-28) y 19,5 (RIQ 4-56) días, respectivamente. Los β-lactámicos anti-estafilocócicos cloxacilina/cefazolina (19,2%) y ciprofloxacino (5,5%) fueron los antimicrobianos más frecuentemente usados por vía IV y oral, respectivamente. Un total de 234 pacientes (68%) fueron sometidos a cirugía, de ellos 113 (32,8%) a desbridamiento, 97 (27,4%) a desbridamiento + colgajo muscular y 24 (7%) a amputación. Un total de 208 pacientes (60,6%) no recidivaron. Los pacientes operados presentaron menos recidivas (p<0,0001). Un total de 23 (6,7%) pacientes fallecieron, 11 (3,2%) por complicaciones infecciosas y 48 (14%) se perdieron durante el seguimiento.

Conclusiones: La osteomielitis se debe a causas diversas que complican su abordaje terapéutico. Los factores de riesgo o microorganismos causales podrían influir en los resultados del tratamiento y en la remisión de la enfermedad. Una cirugía agresiva junto con un tratamiento antimicrobiano adecuado son imprescindibles para obtener la curación

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Conflict of interest statement

The authors declare that they have no conflicts of interest

Figures

Figure 1
Figure 1
Cierny–Mader-Pennick classification of osteomyelitis. Anatomical: I- medullary, II- superficial, III- localized and IV- diffuse. Host immunity: type A host, without comorbidities; type B host, one or two general diseases; and type C host, the risk of surgical treatment exceeds the benefits because of comorbidities
Figure 2
Figure 2
Causes of osteomyelitis
Figure 3
Figure 3
Bones affected.
Figure 4
Figure 4
Inflammatory blood markers changes according to the osteomyelitis cause
Figure 5
Figure 5
Risk factors differences according to the osteomyelitis cause
Figure 6
Figure 6
Surgical approaches according to the osteomyelitis cause
Figure 7
Figure 7
Relapse differences (A) and remission mean time (B) according to the osteomyelitis cause
Figure 8
Figure 8
Relapse differences (A) and remission mean time (B) according to the surgical treatment received
See this image and copyright information in PMC

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