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. 2018 Dec 7;18(1):635.
doi: 10.1186/s12879-018-3550-6.

Factors predictive of relapse in adult bacterial osteomyelitis of long bones

E Garcia Del Pozo  1 , J Collazos  2 , J A Carton  3   4 , D Camporro  1 , V Asensi  5   6
Affiliations

Factors predictive of relapse in adult bacterial osteomyelitis of long bones

E Garcia Del Pozo et al. BMC Infect Dis. .

Abstract

Background: Osteomyelitis is a difficult-to-cure infection with a high relapse rate despite combined medical and surgical therapies. Some severity factors, duration of antimicrobial therapy and type of surgical procedure might influence osteomyelitis relapse.

Methods: 116 patients with osteomyelitis were followed for ≥1 year after hospital discharge. Demographic, microbiological and clinical data, eight severity factors and treatment (surgical and antibiotic) were analyzed.

Results: Mean age was 53 years and 74.1% were men. Tibia (62.1%) and S. aureus (58.5%) were the most commonly involved bone and bacteria, respectively. Mean follow-up was 67.1 months. Forty-six patients underwent bone debridement, 61 debridement plus flap coverage and 9 antimicrobial therapy only. Twenty-six patients (22.4%) relapsed, at a mean of 11.2 months since hospital discharge. Duration > 3 months (p = 0.025), number of severity factors (P = 0.02) and absence of surgery (P = 0.004) were associated with osteomyelitis relapse in the univariate analysis. In the Cox regression analysis, osteomyelitis duration > 3 months (P = 0.012), bone exposure (P = 0.0003) and type of surgery (P < 0.0001) were associated with relapse. Regarding the surgical modalities, bone debridement with muscle flap was associated with better osteomyelitis outcomes, as compared with no surgery (P < 0.0001) and debridement only (P = 0.004).

Conclusions: Osteomyelitis extending for > 3 months, bone exposure and treatment other than surgical debridement with muscular flap are risk factors for osteomyelitis relapse.

Keywords: Antibiotics; Debridement; Muscular flap; Osteomyelitis; Relapse; Severity factors.

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Conflict of interest statement

Authors’ information

These results were presented in part at the ASM Microbe Meeting, New Orleans, LA, 1–5 June 2017; abstract # 243.

Ethics approval and consent to participate

The study was approved by the Research Ethics Committee of the Principado de Asturias. Because this was a retrospective study based on medical records since 1994, no individual informed consent from each participant could be obtained. However, data were analyzed anonymously, and the study was approved by the Research Ethics Committee of the Principado de Asturias.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

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

Figures

Fig. 1
Fig. 1
Kaplan Meier cumulative survival curves of the eight severity factors for osteomyelitis
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve corresponding to the predictive formula
Fig. 3
Fig. 3
Variables independently associated with osteomyelitis relapse in the Cox regression analysis
See this image and copyright information in PMC

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