A comparison of short- and long-term intravenous antibiotic therapy in the postoperative management of adult osteomyelitis

Abstract

T he current standard recommendation for antibiotic therapy in the management of chronic osteomyelitis is intravenous treatment for six weeks. We have compared this regime with short-term intravenous therapy followed by oral dosage.A total of 93 patients, with chronic osteomyelitis, underwent single-stage, aggressive surgical debridement and appropriate soft-tissue coverage. Culture-specific intravenous antibiotics were given for five to seven days, followed by oral therapy for six weeks. During surgery, the scar, including the sinus track, was excised en bloc. We used a high-speed, saline-cooled burr to remove necrotic bone, and osseous laser Doppler flowmetry to ensure that the remaining bone was viable. Infected nonunions (Cierny stage-IV osteomyelitis) were stabilised by internal fixation. In 38 patients management of dead space required antibiotic-impregnated polymethylmethacrylate beads, which were exchanged for an autogenous bone graft at six weeks. Free-tissue transfer often facilitated soft-tissue coverage. These 93 patients were compared with 22 consecutive patients treated previously who had the same surgical management, but received culture-specific intravenous antibiotics for six weeks.Of the 93 patients, 80 healed without further intervention. Of the 31 Cierny-IV lesions, 27 healed without another operation, and four fractures required additional bone grafts. No more wound drainage was needed. Treatment was successful in 91% of patients, regardless of the organism involved. There was no difference in outcome in terms of these variables when the series were compared. We conclude that the long-term administration of intravenous antibiotics is not necessary to achieve a high rate of clinical resolution of wound drainage for adult patients with chronic osteomyelitis.

Chronic osteomyelitis

“…In the 44 patients who had a wide or marginal resection, there were eight (18%) recurrences. Swiontkowski et al 16 reported a recurrence rate of 9% in adult cases of osteomyelitis, but their follow-up ranged from 0 to 62 months and they did not state the host category. Some of these patients had an infected nonunion and would normally be treated with a wide resection.…”

Debridement with high speed burr reduce more colonies of Staphylococcus aureus in chronic osteomyelitis of rabbit's tibia compare to debridement with curettage

“…This study conclude that the long-term administration of intravenous antibiotics is not necessary to achieve a high rate of clinical resolution of wound drainage for adult patients with chronic osteomyelitis. 18 High speed burr also reduce risk of fracture. 6 High speed burr also has Gyroscopic effect, it to rotate about an axis perpendicular to both the torque and the angular momentum, has a profound effect on the resulting stability lobes, especially at very high speeds; also it makes the lobes wider but at the same time lowers the minimum stability boundary.…”

Therapeutic Strategies for Post-Osteosynthesis Osteomyelitis

“…SSI is the third most commmon nosocomial infection which accounts for 14 to 16% of hospitalized patients and 38% of surgical patients [2]. SSI in orthopaedic trauma may vary between 0.9 and 12.5% and the worst complication is osteomyelitis, especially the chronic form [3][4][5][6] Chronic osteomyelitis resulting from post-trauma surgical infection can be treated with aggressive debridment and skin dressing together with intravenous antibiotics for 5 to 7 days followed by 6 weeks of oral antibiotics resulting in fracture consolidation without complications [7][8][9].…”