A modified staging system for chronic osteomyelitis

Marais, Leonard Charles; Ferreira, Nando; Aldous, Colleen; Sartorius, Benn; Roux, Theo L.B. Le

doi:10.1016/j.jor.2015.05.017

Cited by 34 publications

(45 citation statements)

References 32 publications

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“…4 Treatment options for chronic osteomyelitis include curative and palliative management strategies. 5,6 Curative treatment protocols involve a combination of thorough debridement, dead space management, soft tissue reconstruction and adjuvant antibiotic therapy in order to achieve remission of the disease prior to reconstruction. Palliative treatment strategies, may be indicated in compromised hosts who are not suitable for complex surgery.…”

Section: Introductionmentioning

confidence: 99%

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The microbiology of chronic osteomyelitis in a developing world setting

Mthethwa

Marais

2017

SA orthop. j.

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Objectives: The primary aim of this study was to identify the microorganisms that cause chronic osteomyelitis in a developing world clinical setting and to characterise the antibiotic sensitivity profile of these pathogens. Furthermore, we aimed to determine whether the causative organisms vary in relation to physiological status of the host, the HIV status of the patient or the cause of the infection (post-traumatic, post-operative and haematogenous). Methods:We performed a retrospective review of consecutive adult patients treated curatively for chronic osteomyelitis of long bones, over a two-year period. Patient charts were reviewed and data extracted in respect of patient demographics, the cause of infection, physiological status of the host in accordance with the Cierny and Mader classification, HIV status, surgical treatment strategy and causative organism.Results: A total of 108 organisms were identified in the 60 patients included in the study. Multiple organism were cultures in 45% of patients, a single Gram-positive organism in 22% and a single Gram-negative organism in 26% of patients. In four cases (7%) no causative organism was cultured. The most prevalent organisms were Enterobacteriaceae (34%), Staphylococcus spp. (29%), Pseudomonas aeruginosa (11%), and Enterococcus spp. (9%). Many isolates were found to be resistant to commonly used empirical anti-microbial agents. Seventy per cent of Enterobacteriaceae spp. were resistant to either cefuroxime and/or ampicillin-clavulanic acid. Seventy-seven per cent of Staphylococcus aureus isolates were susceptible to cloxacillin. More than 50% of Pseudomonas aeruginosa strains were resistant to meropenem, imipenem, piperacillin-tazobactam or cefepime. There was a significant association between the aetiology of the infection and the microorganisms involved (p-value < 0.01). The bacterial pathogen profile was, however, not associated with the physiological status of the host (p=0.22) or the HIV status of the patient. Conclusion:While the majority of haematogenous chronic osteomyelitis still involved a solitary Gram-positive organism, the incidence of Gram-negative infections was found to be higher than previously reported. Contiguous chronic osteomyelitis was mostly polymicrobial in nature and solitary infections involving a Gramnegative organism was most common in the post-traumatic group. The bacterial pathogen did not vary in relation to the HIV status of the patient or the physiological status of the host.

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Section: Introductionmentioning

confidence: 99%

“…Palliative treatment strategies, may be indicated in compromised hosts who are not suitable for complex surgery. 5,6 Typically palliative treatment involves chronic suppressive antibiotic therapy. Knowledge of the microbiology of chronic osteomyelitis may guide the selection of empiric postoperative or palliative antibiotic therapy.…”

Section: Introductionmentioning

confidence: 99%

The microbiology of chronic osteomyelitis in a developing world setting

Mthethwa

Marais

2017

SA orthop. j.

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“…There are many bone infection classifications such as: 1-Waldvogel et al Classified according to duration (10) . 2-Kelly et al Classified according to etiopathogenesis (10) . 3-Cierny and Mader classified according to anatomo-pathological (10) .…”

Section: Classification Of Chronic Osteomyelitismentioning

confidence: 99%

“…2-Kelly et al Classified according to etiopathogenesis (10) . 3-Cierny and Mader classified according to anatomo-pathological (10) . 4-Gahter classified according to bone defect (10) .…”

Section: Classification Of Chronic Osteomyelitismentioning

confidence: 99%

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Management of Chronic Osteomyelitis Following Gunshot Injuries : A Systematic Review of Literature

Abuharba

Abdelhady

Mansour

2017

Egyptian Journal of Hospital Medicine

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Background: Chronic osteomyelitis of long bones are common in daily clinical practice, however, the treatment of these diseases has still been a challenge and difficult for orthopedic surgeons. Gunshot injuries lead to damage to bone and soft tissues that can complicate with bacterial invasion and cause bone infection. Many ways can overcome of bone infection, surgical debridement, bone fixation and antibiotic are used in management of chronic osteomyelitis. The objective of this systematic review was to review available studies reporting in management of chronic osteomyelitis following gunshot injuries and compare the methods used into the treatment. Methods: A comprehensive literature search was performed from the electronic databases Medline, PubMed, Google scholar, and Cochrane collaboration between 1995 and 2016. References were analyzed from included studies, inclusion criteria included (1) English literatures, (2) Humans clinical trials, (3) Orthopedic Journals only, (3) Definitive treatment strategy for management chronic osteomyelitis. In total, 5 articles were included in the systematic review. Results: A total of 278 patients from 5 studies were included in this systematic review. The mean age of the patients is all studies were 33.84 year, the ratio male to female is 6:1. The most of patients were classified as Gaustilio type lllB and CiernyMader type lllB. The result of all different studies shows a good outcome in 260 patients but 7 patients had poor outcome who were still had bone infection and one patient end by amputation. Radiographic X-ray did postoperative follow up every two weeks. The mean follow up duration was 40 months and all patients responsible for keep the fixator clean. Conclusion: Our systematic review showed that the patients with chronic osteomyelitis were treated by surgical debridement and bone fixation had a good result. But, this research lost the randomized trials methods, risk factors of patients, compare control groups and good statistical analysis. Without any direct comparison of treatment modalities, it is difficult to determine which individual treatment option is the most efficacious.

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Biofilm formation and antimicrobial susceptibility of staphylococci and enterococci from osteomyelitis associated with percutaneous orthopaedic implants

et al. 2016

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Staphylococci and enterococci account for most deep infections associated with bone-anchored percutaneous implants for amputation treatment. Implant-associated infections are difficult to treat; therefore, it is important to investigate if these infections have a biofilm origin and to determine the biofilm antimicrobial susceptibility to improve treatment strategies. The aims were: (i) to test a novel combination of the Calgary biofilm device and a custom-made susceptibility MIC plate (Sensititre ), (ii) to determine the biofilm formation and antimicrobial resistance in clinical isolates causing implant-associated osteomyelitis, and (iii) to describe the associated clinical outcome. Enterococci and staphylococci were characterized by microtitre plate assay, Congo Red Agar plate test, and PCR. Biofilm susceptibility to 10 antimicrobials and its relationship to treatment outcomes were determined. The majority of the strains produced biofilm in vitro showing inter- and intraspecies differences. Biofilms showed a significantly increased antimicrobial resistance compared with their planktonic counterparts. Slime-producing strains tolerated significantly higher antimicrobial concentrations compared with non-producers. All seven staphylococcal strains carried ica genes, but two did not produce slime. The degree of biofilm formation and up-regulated antibiotic resistance may translate into a variable risk of treatment failure. This new method set-up allows for the reproducible determination of minimum biofilm eradication concentration of antimicrobial agents, which may guide future antimicrobial treatment decisions in orthopaedic implant-associated infection. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2630-2640, 2017.

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A modified staging system for chronic osteomyelitis

Abstract: By integrating the redefined host status and treatment strategy, we were able to achieve comparable short-term outcomes in both low and high-risk cases while maintaining a low rate of amputation.

Cited by 34 publications

References 32 publications

The microbiology of chronic osteomyelitis in a developing world setting

The microbiology of chronic osteomyelitis in a developing world setting

Management of Chronic Osteomyelitis Following Gunshot Injuries : A Systematic Review of Literature

Biofilm formation and antimicrobial susceptibility of staphylococci and enterococci from osteomyelitis associated with percutaneous orthopaedic implants

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