Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials?

Lazzarini, Luca; Lipsky, Benjamin A.; Mader, Jon T.

doi:10.1016/j.ijid.2004.09.009

Cited by 268 publications

(174 citation statements)

References 86 publications

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“…Antibiotics with activity predominantly against Gram positive organisms (staphylococci and streptococci) [52] and broad-spectrum antibiotics with increased activity against Gram negative organisms and obligate anaerobes [53] appear equally effective. These findings confirm the results of a recent review of the antibiotic management of all types of osteomyelitis [54]. Nevertheless, it is still not known if antibiotic therapy should be selected on the basis of the sensitivities of all isolated organisms or simply against those judged most likely to be pathogenic.…”

Section: Empirical Choice Of Antibioticsupporting

confidence: 85%

Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment

Berendt

Peters

Баккер³

et al. 2008

Diabetes Metab. Res. Rev.

278

214

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SummaryThe International Working Group on the Diabetic Foot appointed an expert panel to provide evidence-based guidance on the management of osteomyelitis in the diabetic foot. Initially, the panel formulated a consensus scheme for the diagnosis of diabetic foot osteomyelitis (DFO) for research purposes, and undertook a systematic review of the evidence relating to treatment. The consensus diagnostic scheme was based on expert opinion; the systematic review was based on a search for reports of the effectiveness of treatment for DFO published prior to December 2006.The panel reached consensus on a proposed scheme that assesses the probability of DFO, based on clinical findings and the results of imaging and laboratory investigations.The literature review identified 1168 papers, 19 of which fulfilled criteria for detailed data extraction. No significant differences in outcome were associated with any particular treatment strategy. There was no evidence that surgical debridement of the infected bone is routinely necessary. Culture and sensitivity of isolates from bone biopsy may assist in selecting properly targeted antibiotic regimens, but empirical regimens should include agents active against staphylococci, administered either intravenously or orally (with a highly bioavailable agent). There are no data to support the superiority of any particular route of delivery of systemic antibiotics or to inform the optimal duration of antibiotic therapy. No available evidence supports the use of any adjunctive therapies, such as hyperbaric oxygen, granulocyte-colony stimulating factor or larvae.We have proposed a scheme for diagnosing DFO for research purposes. Data to inform treatment choices in DFO are limited, and further research is urgently needed.

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Section: Empirical Choice Of Antibioticsupporting

confidence: 85%

Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment

Berendt

Peters

Баккер³

et al. 2008

Diabetes Metab. Res. Rev.

278

214

View full text Add to dashboard Cite

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“…Therefore, antibiotic therapy is essential. Unfortunately, once bacteria attach to bone or implants, their metabolism is decreased and they cover themselves with a biofilm (glycocalyx) that protects them from antimicrobials, opsonisation and phagocytosis [13,15]. To kill these bacteria in the biofilm, antibiotic concentrations should be 10-to 100-fold the usual bactericidal concentration.…”

Section: Discussionmentioning

confidence: 99%

Cierny-Mader Type III chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics

Kınık

Karaduman

2007

International Orthopaedics (SICO

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Cierny-Mader (C-M) Type III osteomyelitis is defined as a localised lesion with both medullary and cortical involvement that is stable mechanically after debridement. The treatment of C-M Type III osteomyelitisis is difficult and requires a precise protocol to achieve a disease-free longterm follow-up. We report here the results of our study on 26 patients (19 men and 7 women; average age: 34.7 years) with C-M Type III osteomylelitis who were treated with radical debridement, irrigation, vancomycin-impregnated custom-made beads and culture-specific systemic antibiotics. Those patients with metaphyseal involvement were treated with deroofing of the cortex and debridement by means of a "trough" (16 patients); those with diaphyseal involvement were treated with both intramedullary reaming and debridement from a trough (ten patients). Antibiotic cement rods were used as an additional therapy in five patients with diaphyseal involvement. Recurrence developed in three patients and was attributed to inadequate debridement; all three patients were treated again in the same manner with success. The mean follow-up is currently 3.6 years (range: 2-6 years). All of the patients have normal clinical, radiographic and laboratory parameters, and all are ambulatory and have returned to their pretreatment level of activity or better. We conclude that C-M Type III chronic osteomyelitis can be safely treated with this protocol.Résumé L'ostéomyélite de type III Cierny-Mader (C-M) peut se définir comme une localisation de lésions localisées à la fois sur la médullaire et la corticale et qui reste stable sur le plan mécanique après mise à plat. Son traitement est difficile et demande un protocole précis. Pour cette étude, nous avons suivi les résultats de 26 patients (19 hommes et 7 femmes) dont l'âge moyen était de 34.7 ans, traités par mise à plat, irrigation, et billes de vancomycine. Dans les lésions métaphysaires, la mise à plat est réalisée à travers une fenêtre (16 patients), dans les lésions diaphysaires on réalise à la fois un alésage des lésions et une mise à plat par la fenêtre (10 patients). En addition aux billes de vancomycine, un ciment aux antibiotiques a été utilisé chez 5 patients avec lésions diaphysaires. Trois patients ont présenté une récidive secondaire à une mise à plat insuffisante. Tous ces patients ont été à nouveau traités de la même manière et avec succès. Le suivi moyen a été de 3.6 ans (2 à 6 ans) et aucun patient n'a présenté d'anomalie post-opératoire des différents paramètres clinique, radiographique et biologique. Les patients peuvent marcher et ont retrouvé leur activité d'avant le traitement. L'ostéomyé-lite chronique de type III de CM peut être traitée avec succès selon ce protocole.

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“…Although foot infections are severe with potentially disastrous consequences, both for limb and individual, choice of treatment is still empirical and most studies of antibiotics in diabetic foot infections include skin infection only and not ulcers with deep infections [2]. The question of which factors determine whether patients are infected is controversial, and studies with hard endpoints on outcome of infections in diabetic foot ulcers are limited in number [2,34,35]. The total number of infections in our study may be underestimated, as our protocol only included deep infections.…”

Section: Neuropathic Ulcersmentioning

confidence: 99%

Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study

et al. 2008

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Aims/hypothesis We sought to identify factors related to shortterm outcome of foot ulcers in patients with diabetes treated in a multidisciplinary system until healing was achieved. Methods Consecutively presenting patients with diabetes and worst foot ulcer (Wagner grade 1-5, below ankle) (n=2,511) were prospectively followed and treated according to a standardised protocol until healing was achieved or until death. The number of patients lost to dropout was 31.The characteristics of the remaining 2,480 patients were: 1,465 men, age 68±15 years (range 18-96), type 1 diabetes 18%, type 2 diabetes 82% and insulin-treated 62%. Results The healing rate without major amputation in surviving patients was 90.6% (n=1,867). Sixty-five per cent (n=1,617) were healed primarily, 9% (n=250) after minor amputation and 8% after major amputation; 17% (n=420) died unhealed. Out of 2,060 surviving patients, 1,007 were neuroischaemic (48.8%). In a multiple regression analysis, primary healing was related to co-morbidity, duration of diabetes, extent of peripheral vascular disease and type of ulcer. In neuropathic ulcers, deep foot infection, site of ulcer and co-morbidity were related to amputation. Amputation in neuroischaemic ulcers was related to comorbidity, peripheral vascular disease and type of ulcer. Age, sex, duration of diabetes, neuropathy, deformity and duration of ulcer or site of ulcer did not have an evident influence on probability of amputation. Conclusions/interpretation Patients with diabetic foot ulcer suffer from multi-organ disease. Factors related to outcome are correspondingly complex.

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Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials?

Cited by 268 publications

References 86 publications

Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment

Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment

Cierny-Mader Type III chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics

Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study

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