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

Abstract

BackgroundThe incidence of posttraumatic osteomyelitis (PTO) is increasing despite new treatment strategies. Assessment of patients’ outcomes following PTO is challenging due to multiple variables. The study goals are to determine the frequency of recurrence following PTO treatment and identify factors predisposing patients to treatment failure.MethodsBetween August 01, 2007 to August 30, 2012, a single-center retrospective cohort study was performed among 193 patients diagnosed with PTO following orthopedic surgery for fracture care. Bone and soft tissues were collected for cultures and PTO was defined according to CDC/NHSN criteria. Patient, injury, surgery-associated variables, and microbiological records were reviewed for risk factors associated to recurrence of PTO. Univariate and multivariable analyses using logistic regression were performed, with p <0.05 considered significant.ResultsThirty-eight patients (20%) of 192 diagnosed and treated for PTO failed their treatment. Factors associated with recurrence were age between 61 and 80 years [hazard ratio (HR) = 6.086, 95% confidence interval (CI) = 2.459;15.061, p = <0.001], age above 80 years [HR = 9.975 (95% CI = 3.591;27.714), p = <0.001], intraoperative blood transfusion [HR = 2.239 (95% CI = 1.138;4.406), p = 0.020], and positive culture for Pseudomonas aeruginosa [HR = 2.700 (95% CI = 1.370;5.319), p = 0.004].ConclusionsRisk factors associated with recurrence of PTO are difficult to measure. The present study revealed that elderly patients, intraoperative blood transfusions, and infection due to P. aeruginosa were independently associated with recurrence of PTO. These factors should warn clinicians of a higher failure rate following treatment of PTO. Trial registration: ISRCTN71648577. Registered 18 May 2017. Retrospectively registered.

Post-traumatic osteomyelitis in Middle East war-wounded civilians: resistance to first-line antibiotics in selected bacteria over the decade 2006–2016

“…In our study, 60.5% of S. aureus isolated were resistant to oxacillin. Although we observed a slight decline over the study period, this proportion is higher than that reported in recent series of PTO in Brazil (35.5%) and in China (35.9%) [3, 4]. Resistance to other drugs of interest frequently used for osteomyelitis was also common in our patients.…”

“…This group of bacteria was involved in 2.8% of 142 PTO in one American trauma center [6], but in 35.5% of cases in another recent study in China where patients, like those in the Amman MSF program, were frequently suffering from open fracture and/or soft tissue damage following direct trauma [4]. P. aeruginosa was frequent in our study (13.5% of isolates); this is worrisome for PTO patients in Amman given the fact that infections with P. aeruginosa have been found to be associated with increased risk of recurrence of osteomyelitis [3, 6].…”

“…Post-traumatic and diabetes mellitus-related infections are the most frequent causes of osteomyelitis [1, 2]. Two retrospective studies found a rate of post-traumatic osteomyelitis (PTO) after limb fracture of 2.5 and 1.5%, but incidence of PTO depends on the host condition and on the severity of injury; it is much higher after open fractures [3, 4]. The gold standard for diagnosis of PTO is culture of bone biopsy, as deep wound tissue culture lacks sensitivity and specificity [5].…”

Risk Factors Associated with Infection Recurrence of Posttraumatic Osteomyelitis Treated with Ilizarov Bone Transport Technique—A Retrospective Study of 149 Cases

“…In this study, 52.94% (9/17) of patients with recurrence of infections received intraoperative blood transfusion, which was much higher than 22.73% (30/132) of the non-infection recurrence group. In an analysis of 192 patients with post-traumatic osteomyelitis, risk factors for recurrence of infection were analyzed which showed that the risk of infection recurrence in patients receiving blood transfusion was 2 times higher [26] , which is similar to our study. Another study proposed that the risk of multi-microbial infection in patients undergoing blood transfusion during orthopedic surgery is 2.15 times higher than that of patients without blood transfusion [29] .…”

“…Recent studies have suggested that Pseudomonas aeruginosa is directly related to the recurrence of posttraumatic osteomyelitis infection [26] . In summary, in charge surgeon need to be alerted to patients with posttraumatic tibial osteomyelitis caused by Pseudomonas aeruginosa infection…”