Treatment Algorithms for Chronic Osteomyelitis

Walter, Gerhard; Kemmerer, Matthias; Kappler, C.; Hoffmann, Reinhard

doi:10.3238/arztebl.2012.0257

Cited by 146 publications

(183 citation statements)

References 56 publications

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“…Chronic osteomyelitis refers to a long-standing bone infection (3) and is most commonly reported in male adults following trauma or injury (e.g., surgery). It is described as a persistent infection of bones, a painful condition with movement restrictions of the affected limb (4). Untreated chronic osteomyelitis can cause avascular necrosis and formation of osteocyte islands without vessels, containing infection (sequestration).…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Ozone Therapy in Chronic Osteomyelitis: A Randomized Controlled Clinical Trial

Nabi

Sedighinejad

Mirbolouk

et al. 2018

Arch Clin Infect Dis

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Background: Treatment of chronic osteomyelitis is complex and includes long-term management with antibiotics and debridement. Inadequate blood supply, underlying diseases, and deep involvement of the infected area can cause classic treatments to fail and lead to serious complications, such as limb amputation. Recently, there has been increasing interest in the use of ozone therapy for infectious diseases. Objectives: This study was designed to investigate the beneficial effects of ozone therapy on chronic osteomyelitis. Methods: Sixty patients with chronic osteomyelitis were divided into two homogenized groups: ozone therapy and control. Ozone therapy at a concentration of 30 mg/mL was performed daily by ozone bagging, minor autohemotherapy, and ozone saline injection into the bone. Data were analyzed to determine recovery and erythrocyte sedimentation rates. Results: The recovery rate was 73.33% in the control group versus 86.66% in the ozone group (P = 0.31). No significant difference was found between the groups regarding the recovery rate (P = 0.86). However, considering the erythrocyte sedimentation rate, the results were significantly superior in the ozone group (P = 0.0001). Conclusions: These findings indicate that ozone therapy, as a promising complementary treatment, can be applied in chronic osteomyelitis management.

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Section: Introductionmentioning

confidence: 99%

The Effectiveness of Ozone Therapy in Chronic Osteomyelitis: A Randomized Controlled Clinical Trial

Nabi

Sedighinejad

Mirbolouk

et al. 2018

Arch Clin Infect Dis

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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%

“…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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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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“…This leads to enormous socioeconomic costs which in turn leads to an increasing need for research and new antibiotics to fight MRSA infections [19]. The optimal treatment for orthopaedic MRSA infections involves both surgery and medical treatment [2]. A radical surgical debridement should be followed by an extended period of appropriate antibiotic treatment.…”

Section: Discussionmentioning

confidence: 99%

“…With regard to periprosthetic implant infection, Staphyloccus aureus remains the most prevalent pathogen. The current gold standard therapy includes a surgical debridement supported by long-term administration of anti-microbiological agents [2]. However, the recent increase in resistant strains such as methicillin-resistant Staphylococcus aureus (MRSA) is a significant global healthcare problem particularly within hospitals [3].…”

Section: Introductionmentioning

confidence: 99%

Establishment of a new methicillin resistant staphylococcus aureus animal model of osteomyelitis

Helbig

Simank²,

Lorenz

et al. 2013

International Orthopaedics (SICOT)

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Purpose The increase in methicillin-resistant Staphylococcus aureus (MRSA) infections is currently a major health care problem. Vancomycin is still often the first-line antimicrobiological agent for treating such infections; however, a recent decline in efficacy of vancomycin in MRSA infections has raised concerns and accelerated the search for new antibiotics. The aim of this study was to establish a MRSA peri-implant osteomyelitis animal model for future testing of new anti-microbiological agents under typical MRSA infection conditions.

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Treatment Algorithms for Chronic Osteomyelitis

Abstract: Surgery combined with anti-infective chemotherapy leads to long-lasting containment of infection in 70% to 90% of cases. Suitable drugs are not yet available for the eradication of biofilm-producing bacteria.

Cited by 146 publications

References 56 publications

The Effectiveness of Ozone Therapy in Chronic Osteomyelitis: A Randomized Controlled Clinical Trial

The Effectiveness of Ozone Therapy in Chronic Osteomyelitis: A Randomized Controlled Clinical Trial

The microbiology of chronic osteomyelitis in a developing world setting

Establishment of a new methicillin resistant staphylococcus aureus animal model of osteomyelitis

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