Clinical Characteristics and Treatment of Extremity Chronic Osteomyelitis in Southern China

Abstract

Although extremity chronic osteomyelitis is common in China, updated data were still limited regarding its characterizations. The present study aimed to review clinical features of extremity chronic osteomyelitis in Southern China.A retrospective analysis was conducted in the patients who had sought medical attention from January 2010 to April 2015 for extremity chronic osteomyelitis in Nanfang Hospital in Southern China. Clinical data were collected and analyzed.A total of 394 patients (307 males and 87 females) were included, giving a gender ratio of 3.53. The median age at first diagnosis was 42 years for all. The most frequent type was traumatic osteomyelitis (262 cases, 66.50%), which was mainly caused by open injury (166 cases, 63.36%) and during a road accident (91 cases, 34.73%). Single-site infection accounted for 81.98% (323 cases), with tibia (126 cases), femur (79 cases), calcaneus (37 cases), and toes (37 cases) as the top sites. The positive rate of intraoperative culture was 70.63% (214/303), 78.97% (169/214) of which was monomicrobial infection. Staphylococcus aureus (59 cases) was the most frequent bacteria for monomicrobial infection, followed by Pseudomonas aeruginosa (29 cases) and Escherichia coli (11 cases). The positive ratios of preoperative serum white blood cell (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) were 21.63%, 64.92%, 53.27%, 42.25%, 72.82%, and 66.67%, respectively. The most frequently used intravenous antibiotic was cephalosporins. The overall cure rate was 77.74%, with a total amputation rate of 16.75%.In this representative Chinese cohort, extremity chronic osteomyelitis was mostly caused by open injury and during a road accident, predominated in males and favored the tibia. S. aureus was the most frequent pathogenic organism. Preoperative elevated levels of serum IL-6, TNF-α, and ESR may be helpful diagnostic indicators of the disease. Most patients achieved a favorable clinical efficacy after appropriate treatment.

A study of prevalence of staphylococcus aureus and its antibiotic susceptibility pattern in 100 osteomyelitis patients in a tertiary care teaching hospital

“…In our study, osteomyelitis cases were more common in males (76%) as compared to females (24%) with a male: female ratio of 3.16:1. Similar results were reported by Kumar A et al [8] , Jiang N et al [9] and Singh A et al [10] who showed male: female ratio to be 2.72:1, 3.53:1 and 2.7:1 respectively. In the current study, the most common predisposing factor leading to osteomyelitis was trauma due to road side accidents accounting for 45% cases followed by post-operative infections (21%), orthopaedic implants (17%), haematogenous (11%), diabetes mellitus (4%) and others.…”

Predisposing factors for recurrence of chronic posttraumatic osteomyelitis: a retrospective observational cohort study from a tertiary referral center in Brazil

“…Contamination by a myriad of pathogenic Gram-negative bacteria is not only found in open fractures, but in recent studies involving trauma centers of developing countries, P. aeruginosa has been increasingly identified as the causative organism in secondary hospital-acquired osteomyelitis and implant-associated infections [4, 6, 8, 31, 32]. In this study, P. aeruginosa accounted for the second most common isolated bacteria on patients with PTO and was strongly associated with recurrent infections in the multivariate analysis.…”

“…On the other hand, a Chinese cohort study addressing the epidemiology of COM confirmed its rising frequency, especially among previously healthy young adults involved in road traffic accidents and interpersonal violence [8]. The combination of prompt diagnosis, aggressive surgical debridement, and targeted administration of antibiotics may help reduce the growing frequency of PTO, especially among populations in the developing world [9, 10].…”

Epidemiology, Microbiology and Therapeutic Consequences of Chronic Osteomyelitis in Northern China: A Retrospective Analysis of 255 Patients

“…Wang et al [8] reports that in southwest China, the top two infection sites are tibia (57.5%) and femur (26.8%). Jiang et al [9] reported a similar result for southern China, finding the most frequent single infection site was the tibia (39.00%), followed by the femur (24.46%), and calcaneus (11.46%). One possible reason for this difference between north and south China could be the dense population found in southern China, leading to more frequent road and industrial accidents.…”

“…It also poses great challenges for orthopedists [7]. Wang [8] and Jiang et al [9] provide recent data on the epidemiology of chronic osteomyelitis in southwest and southern China, which can be used by local government policy-makers and by clinicians. However, China is a country of great diversity in its population, climate and culture.…”