Journal articles on the topic 'Osteomyelitis (OM)'
To see the other types of publications on this topic, follow the link: Osteomyelitis (OM).
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Osteomyelitis (OM).'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Peng, Kuo-Ti, Tsung-Yu Huang, Yao-Chang Chiang, Yu-Yi Hsu, Fang-Yi Chuang, Chiang-Wen Lee, and Pey-Jium Chang. "Comparison of Methicillin-Resistant Staphylococcus aureus Isolates from Cellulitis and from Osteomyelitis in a Taiwan Hospital, 2016–2018." Journal of Clinical Medicine 8, no. 6 (June 7, 2019): 816. http://dx.doi.org/10.3390/jcm8060816.
Full textAbstract:
Methicillin-resistant Staphylococcus aureus (MRSA) causes superficial infections such as cellulitis or invasive infections such as osteomyelitis; however, differences in MRSA isolates from cellulitis (CL-MRSA) and from osteomyelitis (OM-MRSA) at the same local area remain largely unknown. A total of 221 MRSA isolates including 106 CL-MRSA strains and 115 OM-MRSA strains were collected at Chang-Gung Memorial Hospital in Taiwan between 2016 and 2018, and their genotypic and phenotypic characteristics were compared. We found that OM-MRSA isolates significantly exhibited higher rates of resistance to multiple antibiotics than CL-MRSA isolates. Genotypically, OM-MRSA isolates had higher proportions of the SCCmec type III, the sequence type ST239, and the spa type t037 than CL-MRSA isolates. Besides the multidrug-resistant lineage ST239-t037-SCCmecIII more prevalent in OM-MRSA, higher antibiotic resistance rates were also observed in several other prevalent lineages in OM-MRSA as compared to the same lineages in CL-MRSA. Furthermore, when prosthetic joint infection (PJI) associated and non-PJI-associated MRSA strains in osteomyelitis were compared, no significant differences were observed in antibiotic resistance rates between the two groups, albeit more diverse genotypes were found in non-PJI-associated MRSA. Our findings therefore suggest that deep infections may allow MRSA to evade antibiotic attack and facilitate the convergent evolution and selection of multidrug-resistant lineages.
2
Kim, Jiye, Gilsung Yoo, Taesic Lee, Jeong Ho Kim, Dong Min Seo, and Juwon Kim. "Classification Model for Diabetic Foot, Necrotizing Fasciitis, and Osteomyelitis." Biology 11, no. 9 (September 3, 2022): 1310. http://dx.doi.org/10.3390/biology11091310.
Full textAbstract:
Diabetic foot ulcers (DFUs) and their life-threatening complications, such as necrotizing fasciitis (NF) and osteomyelitis (OM), increase the healthcare cost, morbidity and mortality in patients with diabetes mellitus. While the early recognition of these complications could improve the clinical outcome of diabetic patients, it is not straightforward to achieve in the usual clinical settings. In this study, we proposed a classification model for diabetic foot, NF and OM. To select features for the classification model, multidisciplinary teams were organized and data were collected based on a literature search and automatic platform. A dataset of 1581 patients (728 diabetic foot, 76 NF, and 777 OM) was divided into training and validation datasets at a ratio of 7:3 to be analyzed. The final prediction models based on training dataset exhibited areas under the receiver operating curve (AUC) of the 0.80 and 0.73 for NF model and OM model, respectively, in validation sets. In conclusion, our classification models for NF and OM showed remarkable discriminatory power and easy applicability in patients with DFU.
3
Torrence, Garneisha M., and Brian M. Schmidt. "Fungal Osteomyelitis in Diabetic Foot Infections: A Case Series and Comparative Analysis." International Journal of Lower Extremity Wounds 17, no. 3 (August 9, 2018): 184–89. http://dx.doi.org/10.1177/1534734618791607.
Full textAbstract:
Fungal osteomyelitis (OM) is relatively rare. There is scarce literature discussing fungal OM in diabetic foot infections (DFIs). This case series explores the clinical characteristics of patients treated at a large tertiary academic center for DFI and found to have a causative agent of fungal origin in their bone on surgical intervention. Between July 2017 and March 2018, a prospective longitudinal analysis was performed of patients with diabetes admitted to our institution who underwent operative management of OM. Demographic, clinical, radiographic, and laboratory data were collected for all patients. Data between bacterial and fungal OM cohorts was analyzed for differences and similarities in patient characteristics and outcomes. All patients were followed 20 weeks postoperatively. Five patients with fungal OM were identified from the 35 cases where OM was confirmed through podiatric surgical intervention. In each fungal case, a Candida species was isolated from operative bone culture which included subspecies Candida albicans, C parapsilosis, and C glabrata. A P value ⩾.05 was found in clinical characteristics between our cohorts. Wound healing was achieved in 40% of patients with fungal OM, and oral fluconazole successfully treated Candida OM in the cases that achieved healing. Diabetes can increase the risk of Candida OM. In DFIs, fungus can impede wound healing if not recognized and treated. Because Candida OM is typically indolent in nature, bone biopsy and mycological culture is recommended for definitive diagnosis and treatment.
4
Massaccesi, Luca, Emanuela Galliera, Antonio Pellegrini, Giuseppe Banfi, and Massimiliano Marco Corsi Romanelli. "Osteomyelitis, Oxidative Stress and Related Biomarkers." Antioxidants 11, no. 6 (May 27, 2022): 1061. http://dx.doi.org/10.3390/antiox11061061.
Full textAbstract:
Bone is a very dynamic tissue, subject to continuous renewal to maintain homeostasis through bone remodeling, a process promoted by two cell types: osteoblasts, of mesenchymal derivation, are responsible for the deposition of new material, and osteoclasts, which are hematopoietic cells, responsible for bone resorption. Osteomyelitis (OM) is an invasive infectious process, with several etiological agents, the most common being Staphylococcus aureus, affecting bone or bone marrow, and severely impairing bone homeostasis, resulting in osteolysis. One of the characteristic features of OM is a strong state of oxidative stress (OS) with severe consequences on the delicate balance between osteoblastogenesis and osteoclastogenesis. Here we describe this, analyzing the effects of OS in bone remodeling and discussing the need for new, easy-to-measure and widely available OS biomarkers that will provide valid support in the management of the disease.
5
Preiss, Helga, Philipp Kriechling, Giulia Montrasio, Tanja Huber, İmke Janssen, Andreea Moldovan, Benjamin A. Lipsky, and İlker Uçkay. "Oral Flucloxacillin for Treating Osteomyelitis: A Narrative Review of Clinical Practice." Journal of Bone and Joint Infection 5, no. 1 (January 1, 2020): 16–24. http://dx.doi.org/10.7150/jbji.40667.
Full textAbstract:
Abstract. Flucloxacillin (FLU) administered by the oral route is widely used for treating various infections, but there are no published retrospective or prospective trials of its efficacy, or its advantages or disadvantages compared to parenteral treatment or other antibiotics for treating osteomyelitis. Based on published in vitro data and expert opinions, other non-β-lactam oral antibiotics that have better bone penetration are generally preferred over oral FLU. We reviewed the literature for studies of oral FLU as therapy of osteomyelitis (OM), stratified by acute versus chronic and pediatric versus adult cases. In striking contrast to the prevailing opinions and the few descriptive data available, we found that treatment of OM with oral FLU does not appear to be associated with more clinical failures compared to other oral antibiotic agents. Because of its narrow antibiotic spectrum, infrequent severe adverse effects, and low cost, oral FLU is widely used in clinical practice. We therefore call for investigators to conduct prospective trials investigating the effectiveness and potential advantages of oral FLU for treating OM.
6
Iles, Kathleen A., Lori Chrisco, Stephen Heisler, Booker King, Felicia N. Williams, and Rabia Nizamani. "122 In Patients with Lower Extremity Burns and Osteomyelitis, Diabetes Mellitus Increases Amputation Rate." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S81—S82. http://dx.doi.org/10.1093/jbcr/irab032.126.
Full textAbstract:
Abstract Introduction Diabetes mellitus (DM) is a critical comorbidity with burn injury due to the disrupted healing process. Previous reports have confirmed the increased rate of osteomyelitis (OM) and subsequent amputation in this cohort, however this has yet to be studied in comparison to non-diabetic patients. In this retrospective analysis, we investigate OM and amputation in both the diabetic and non-diabetic lower extremity burn populations to determine the impact of DM on these outcomes. Methods The burn registry was used to identify all patients admitted to our tertiary burn center from January 1, 2014 to December 31, 2018. Only patients with lower extremity burns (foot and/or ankle) were included. Patients with burns to additional body areas were excluded. Amputations were categorized by time from injury. Statistical analysis was performed using Student’s t test, chi-squared test, and Fischer’s exact test. Results Of the 315 patients identified, 103 had a known diagnosis of DM and 212 did not. Scald injury was the most common mechanism and average TBSA was similar. Differences were observed in average length of stay (LOS) and admission cost, with diabetics demonstrating both a higher LOS (13.7 days vs 9.2 days, p-value= 0.0016) and cost ($72,883 vs $50,500, p-value= 0.0058) (Table 1). In total, 17 patients were found to have radiologically confirmed OM within three months of the burn injury. Fifteen of these patients had a history of DM and two had no history of DM (p-value= < 0.001) (Table 2). The DM OM patients were found to have a higher blood glucose level on admission (219 mg/dL vs 110 mg/dL, p-value= 0.0452). No significant difference was seen in Hgb A1c in diabetics with or without OM (9.26% vs 8.81%, p= 0.2743). Notably, when non-diabetics were diagnosed with OM, significant differences were observed in both LOS and cost in comparison to their counterparts without OM (36 days vs 9 days; p= 0.0003; $226,289 vs $48,818, p=0.0001). Of the 11 patients who required an amputation, 10 (90.9%) of these patients had comorbid DM. Conclusions DM patients with lower extremity burns are more likely to develop OM than their non-diabetic counterparts. When radiologically confirmed OM is present, DM patients have an increased rate of amputation. OM incurs significant healthcare utilization and cost in both the diabetic and non-diabetic populations.
7
Almawi, Wassim Y., Najat Mahdi, Khadija Al-Ola, Muhallab E. Ali, and Abeer M. Al-Subaie. "Evidence for HLA Class II Susceptible and Protective Haplotypes for Osteomyelitis in Pediatric Patients with Sickle Cell Anemia." Blood 110, no. 11 (November 16, 2007): 3784. http://dx.doi.org/10.1182/blood.v110.11.3784.3784.
Full textAbstract:
Abstract Background and Objective: Osteomyelitis (OM) is a common complication and significant cause of morbidity in patients with sickle cell anemia (SCA); however, its mechanisms are poorly understood. In view of their link to inflammatory diseases and autoimmune disorders, we investigated the association of HLA class II alleles and haplotypes with the pathogenesis of OM in Bahraini SCA patients. Patients and Methods. SCA patients comprised 42 with and 150 patients without OM; HLA-DRB1* and -DQB1* genotyping was done by PCR-SSP. HLA allele frequency was determined by the gene counting method, and haplotype frequency was determined by the maximum-likelihood method. Results. At the allele level, only DRB1*100101 (0.229 vs. 0.082, Pc = 0.003) was positively associated with OM after applying the Bonferrni correction factor. At the haplotype level, DRB1*070101-DQB1*0201 (Pc = 0.001), and DRB1*100101-DQB1*050101 (Pc = 0.001) were more prevalent among patients, while DRB1*030101-DQB1*0201 (Pc = 0.020) and DRB1*040101-DQB1*0302 (Pc = 0.039) was more prevalent among controls, thereby conferring disease susceptibility or protection to these DRB1*-DQB1* haplotypes, respectively. Conclusion. These results demonstrate that specific HLA halpotypes influence osteomyelitis risk in SCA, thereby suggesting that specific HLA types may serve as a marker for identifying SCA patients at high risk for osteomyelitis. HLA-DRB1* and DQB1* Haplotype Frequencies Haplotype OM Patients Controls P Pc OR DRB1*030101-DQB1*0201 0.015 0.141 0.002 0.020 0.07 DRB1*030201-DQB1*0401 0.042 0.016 0.212 0.908 2.95 DRB1*040101-DQB1*0302 0.016 0.126 0.004 0.039 0.08 DRB1*070101-DQB1*0201 0.219 0.060 <0.001 0.001 4.58 DRB1*110101-DQB1*030101 0.056 0.108 0.278 0.962 0.53 DRB1*100101-DQB1*050101 0.208 0.063 <0.001 0.001 4.03 DRB1*130101-DQB1*060101 0.042 0.034 0.773 1.000 1.45 DRB1*150101-DQB1*060101 0.085 0.068 0.774 1.000 1.27 DRB1*160101-DQB1*0201 0.064 0.020 0.121 0.725 3.10 DRB1*160101-DQB1*050101 0.011 0.099 0.016 0.149 0.11
8
Chen, Peng, Qing-rong Lin, Mou-Zhang Huang, Xin Zhang, Yan-jun Hu, Jing Chen, Nan Jiang, and Bin Yu. "Devascularized Bone Surface Culture: A Novel Strategy for Identifying Osteomyelitis-Related Pathogens." Journal of Personalized Medicine 12, no. 12 (December 12, 2022): 2050. http://dx.doi.org/10.3390/jpm12122050.
Full textAbstract:
The gold standard for identifying pathogens causing osteomyelitis (OM) is intraoperative tissue sampling culture (TSC). However, its positive rate remains inadequate. Here, we evaluated the efficiency of a novel strategy, known as devitalized bone surface culture (BSC), for detecting OM-related microorganisms and compared it to TSC. Between December 2021 and July 2022, patients diagnosed with OM and received both methods for bacterial identification were screened for analysis. In total, 51 cases were finally recruited for analysis. The mean age was 43.6 years, with the tibia as the top infection site. The positive rate of BSC was relatively higher than that of TSC (74.5% vs. 58.8%, p = 0.093), though no statistical difference was achieved. Both BSC and TSC detected definite pathogens in 29 patients, and their results were in accordance with each other. The most frequent microorganism identified by the BSC method was Staphylococcus aureus. Moreover, BSC took a significantly shorter median culture time than TSC (1.0 days vs. 3.0 days, p < 0.001). In summary, BSC may be superior to TSC for identifying OM-associated pathogens, with a higher detectable rate and a shorter culture time.
9
Jansen, Jeffrey W., and Ryan P. Moenster. "Clinical Outcomes of Antipseudomonal vs. Non-Antipseudomonal Therapy in Patients with Osteomyelitis." Open Forum Infectious Diseases 4, suppl_1 (2017): S97. http://dx.doi.org/10.1093/ofid/ofx163.074.
Full textAbstract:
Abstract Background Osteomyelitis (OM) in diabetics is frequently a polymicrobial infection that rarely involves Pseudomonas (4–5% of cases). Bone cultures have a low-positive yield of 34–50% and, as a result, many patients receive antimicrobial regimens which include antipseudomonal (AP) therapy. Methods A retrospective cohort analysis of adult Veterans with OM treated with AP compared with non-antipseudomonal (NAP) therapy was conducted. Patients managed by the VA St. Louis outpatient parenteral antimicrobial therapy (OPAT) service from 1/1/2009 to 7/31/2015 were identified and screened for inclusion. Patients with culture negative (CN) or non-pseudomonal superficial swab cultures (SCx) were included. Figure 1 presents the study profile and exclusion criteria. The primary outcome was clinical failure, defined as a composite of: (1) extension of antibiotics beyond 1 week of the planned duration, (2) recurrence of OM at the same anatomical site within 12 months, or (3) any unplanned surgery or amputation at the anatomical site within 12 months of ABx completion. Results Overall, 104 patients with 109 OM encounters were included; there were 29 CN encounters and 80 SCx encounters. Table 1 presents baseline demographics. The overall failure rate was 55/109 (50.5%). The results of the analysis are shown in Table 2. While not included in the primary analysis, Pseudomonas was isolated from 8/88 (9.1%) swab cultures and 5/33 (15%) deep cultures. Conclusion Empiric AP therapy did not improve clinical outcomes in patients with either CN or SCx OM. Disclosures All authors: No reported disclosures.
10
Grbic, Rade, Dijana J. Miric, Bojana Kisic, Ljiljana Popovic, Vojkan Nestorovic, and Aleksandar Vasic. "Sequential Analysis of Oxidative Stress Markers and Vitamin C Status in Acute Bacterial Osteomyelitis." Mediators of Inflammation 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/975061.
Full textAbstract:
In bacterial bone infections, excessively formed oxidants may result in local and systemic oxidative stress. Vitamin C is the major extracellular nonenzymatic antioxidant, also implicated in bone cells metabolism and viability. The physiological functions of vitamin C largely depend on its redox status. We sequentially assessed oxidative stress markers, hydroperoxides and malondialdehyde (MDA), total antioxidant activity (AOA), total vitamin C, ascorbic acid (Asc), and oxidized/reduced vitamin C ratio in 137 patients with acute osteomyelitis (OM). Compared to 52 healthy controls, in OM group baseline serum hydroperoxides, MDA and oxidized/reduced vitamin C ratio were higher whilst Asc and AOA were lower (P < 0.05, resp.). On the other side, total vitamin C levels in patients and controls were similar(P > 0.05), thereby suggesting a relative rather than absolute vitamin C deficiency in OM. During the follow-up, oxidative stress markers, AOA, and oxidizedreduced vitamin C ratio were gradually returned to normal, while there was no apparent change of total vitamin C concentrations. Persistently high values of oxidized/reduced vitamin C ratio and serum MDA were found in subacute OM. In conclusion, acute OM was associated with enhanced systemic oxidative stress and the shift of vitamin C redox status towards oxidized forms.
11
Liesaus, Y. N., S. Wirth, and C. A. Marschner. "Radiologische Bildgebung der Osteomyelitis." Osteologie 26, no. 04 (2017): 194–202. http://dx.doi.org/10.1055/s-0038-1628297.
Full textAbstract:
ZusammenfassungIn der Radiologie gilt die Osteomyelitis (OM) klassisch und zu Recht als diagnostisches Chamäleon. Das liegt an der breiten Alters-verteilung, den verschiedenen und nicht selten multifaktoriellen Ursachen und den resultierenden, manchmal sehr unterschiedlichen Erscheinungsformen. Die in den Bildern häufig ähnlichen Differenzialdiagnosen, z. B. aseptische Knochennekrosen oder Knochentumoren, würden eine völlig andere Behandlungskonsequenz nach sich ziehen. Eine schnelle und präzise Diagnostik ist daher Voraussetzung für eine optimale Therapie -gestaltung. Hierfür ist die Einbeziehung des Patientenalters, der Anamnese sowie der klinischen und laborchemischen Untersuchungen unerlässlich. Bei der radiologischen Diagnostik ist die MRT heute am sensitivsten, aber nicht unbedingt immer am spezifischsten. Oft ist die Osteomyelitis von einer Weichteilreaktion begleitet, zu deren Detektion sich insbesondere bei Kindern zunächst eine Sonografie in Kombination mit einer Radiografie bewährt hat. Die wichtigsten radio-logischen Zeichen sind in Abhängigkeit der Untersuchungsmodalität u. a.: spongiöse/kortikale Destruktion, umgebende Periost- und/ oder Weichteilreaktion, Ödembildung, Diffusionsstörung (native MRT) oder fokale KM-Affinität in Schnittbilduntersuchungen.
12
Al Shukaili, Ahmed khalifa, Ahmed Abdullah Al Kharusi, Eyad Tbaileh, Hanan Nazir, Sameer Raniga, Alaa Al Manzalawy, Mohamed Ebrahim Mohamed Ebrahim Elshinawy, et al. "Clinical and Magnetic Resonance Imaging (MRI) Decision Making Rules in Differentiating Vaso-Occlusive Crises (VOCs) from Osteomyelitis in Paediatric Sickle Cell Population: Is MRI Pathognomonic?" Blood 134, Supplement_1 (November 13, 2019): 4824. http://dx.doi.org/10.1182/blood-2019-130861.
Full textAbstract:
Objectives: Distinguishing between acute presentations of osteomyelitis (OM) and vaso-occlusive crisis (VOC) bone infarction in children with sickle cell disease (SCD) remains challenging for clinicians, particularly in culture-negative cases. VOC and osteomyelitis have a very similar presentation in the acute stage, and both are associated with a rise in C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR). The gold standard to diagnose osteomyelitis is obtaining a positive blood culture and bone/joint biopsy which is invasive and not frequently done. Standard magnetic resonance imaging (MRI) with fat suppression sequencing (subtraction technique) may help to confirm osteomyelitis in SCD patients; however, this is frequently not done in a timely manner and is associated with false positive and false negative results. The objective of this study is to assess the discriminative impact of baseline variable and build a score to assess the diagnosis of osteomyelitis in pediatric patients with SCD. Methods: A retrospective study of all patients with SCD, aged 1 to 18 years old with suspected osteomyelitis. The study covered a period of over 4 years (January 2015- June 2019) at Sultan Qaboos University Hospital, which is the main tertiary care and referral facility in Oman. All the patients were subjected to a complete clinical assessment, laboratory blood tests including, CBC, CRP, blood and aspirated fluid (if applicable) culture, and standard MRI with fat suppression sequencing of the affected bone. A clinical and laboratory score was designed to test whether it can help to prove or disprove the diagnosis in likely cases (Table 1). Results: A total of 43 patients fulfilled the inclusion criteria. Their mean age was 8.7 years +/-3.4. Male to female ratio was 1.87:1. All patients have been initiated on antibiotic therapy as osteomyelitis based on the clinical suspicion and MRI findings. The mean score in the 11 patients with confirmed osteomyelitis was 11/13. Thirteen patients were classified as likely osteomyelitis. Their mean score was 7.5/13. Seventeen patients were confirmed to have VOC by the clinical course (fast resolution of fever, local signs of inflammation and the drop in inflammatory markers). Their mean score was 5.7/13 (Table 2). Conclusion: Differentiating VOC from osteomyelitis in children with SCD who present with fever and bone pain is a difficult task. Our proposed score assigned different mean score to different clinical entity (confirmed OM vs. likely OM vs. VOC). This score may assist clinicians to differentiate these entities. A larger prospective study is needed to confirm and validate the score. Disclosures Tbaileh: Sultan Qaboos University Hospital: Other: Data Collection, Data Input , Discussion of data with my seniors. Al-Khabori:Roche: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; SOBI: Honoraria; AstraZeneca: Honoraria; NovoNardisk: Membership on an entity's Board of Directors or advisory committees; Servier: Membership on an entity's Board of Directors or advisory committees; Shire (Takeda): Membership on an entity's Board of Directors or advisory committees. Wali:Sultan Qaboos University Hospital: Employment.
13
Niemann, Marcel, Frank Graef, Sufian S. Ahmad, Karl F. Braun, Ulrich Stöckle, Andrej Trampuz, and Sebastian Meller. "Outcome Analysis of the Use of Cerament® in Patients with Chronic Osteomyelitis and Corticomedullary Defects." Diagnostics 12, no. 5 (May 11, 2022): 1207. http://dx.doi.org/10.3390/diagnostics12051207.
Full textAbstract:
Background: Chronic osteomyelitis (OM) is a progressive but mostly low-grade infection of the bones. The management of this disease is highly challenging for physicians. Despite systematic treatment approaches, recurrence rates are high. Further, functional and patient-reported outcome data are lacking, especially after osseous defects are filled with bioresorbable antibiotic carriers. Objective: To assess functional and patient-reported outcome measures (PROM) following the administration of Cerament® G or V due to corticomedullary defects in chronic OM. Methods: We conducted a retrospective study from 2015 to 2020, including all patients who received Cerament® for the aforementioned reason. Patients were diagnosed and treated in accordance with globally valid recommendations, and corticomedullary defects were filled with Cerament® G or V, depending on the expected germ spectrum. Patients were systematically followed up, and outcome measures were collected during outpatient clinic visits. Results: Twenty patients with Cierny and Mader type III OM were included in this study and followed up for 20.2 ± 17.2 months (95%CI 12.1–28.3). Ten of these patients needed at least one revision (2.0 ± 1.3 revisions per patient (95%CI 1.1–2.9) during the study period due to OM persistence or local wound complications. There were no statistically significant differences in functional scores or PROMs between groups. Conclusion: The use of Cerament® G and V in chronic OM patients with corticomedullary defects appears to have good functional outcomes and satisfactory PROMs. However, the observed rate of local wound complications and the OM persistence rate may be higher when compared to previously published data.
14
de Graaf, Hans, Priya Sukhtankar, Barbara Arch, Nusreen Ahmad, Amanda Lees, Abigail Bennett, Catherine Spowart, et al. "Duration of intravenous antibiotic therapy for children with acute osteomyelitis or septic arthritis: a feasibility study." Health Technology Assessment 21, no. 48 (September 2017): 1–164. http://dx.doi.org/10.3310/hta21480.
Full textAbstract:
BackgroundThere is little current consensus regarding the route or duration of antibiotic treatment for acute osteomyelitis (OM) and septic arthritis (SA) in children.ObjectiveTo assess the overall feasibility and inform the design of a future randomised controlled trial (RCT) to reduce the duration of intravenous (i.v.) antibiotic use in paediatric OM and SA.Design(1) A prospective service evaluation (cohort study) to determine the current disease spectrum and UK clinical practice in paediatric OM/SA; (2) a prospective cohort substudy to assess the use of targeted polymerase chain reaction (PCR) in diagnosing paediatric OM/SA; (3) a qualitative study to explore families’ views and experiences of OM/SA; and (4) the development of a core outcome set via a systematic review of literature, Delphi clinician survey and stakeholder consensus meeting.SettingForty-four UK secondary and tertiary UK centres (service evaluation).ParticipantsChildren with OM/SA.InterventionsPCR diagnostics were compared with culture as standard of care. Semistructured interviews were used in the qualitative study.ResultsData were obtained on 313 cases of OM/SA, of which 218 (61.2%) were defined as simple disease and 95 (26.7%) were defined as complex disease. The epidemiology of paediatric OM/SA in this study was consistent with existing European data. Children who met oral switch criteria less than 7 days from starting i.v. antibiotics were less likely to experience treatment failure (9.6%) than children who met oral switch criteria after 7 days of i.v. therapy (16.1% when switch was between 1 and 2 weeks; 18.2% when switch was > 2 weeks). In 24 out of 32 simple cases (75%) and 8 out of 12 complex cases (67%) in which the targeted PCR was used, a pathogen was detected. The qualitative study demonstrated the importance to parents and children of consideration of short- and long-term outcomes meaningful to families themselves. The consensus meeting agreed on the following outcomes: rehospitalisation or recurrence of symptoms while on oral antibiotics, recurrence of infection, disability at follow-up, symptom free at 1 year, limb shortening or deformity, chronic OM or arthritis, amputation or fasciotomy, death, need for paediatric intensive care, and line infection. Oral switch criteria were identified, including resolution of fever for ≥ 48 hours, tolerating oral food and medicines, and pain improvement.LimitationsData were collected in a 6-month period, which might not have been representative, and follow-up data for long-term complications are limited.ConclusionsA future RCT would need to recruit from all tertiary and most secondary UK hospitals. Clinicians have implemented early oral switch for selected patients with simple disease without formal clinical trial evidence of safety. However, the current criteria by which decisions to make the oral switch are made are not clearly established or evidence based.Future workA RCT in simple OM and SA comparing shorter- or longer-course i.v. therapy is feasible in children randomised after oral switch criteria are met after 7 days of i.v. therapy, excluding children meeting oral switch criteria in the first week of i.v. therapy. This study design meets clinician preferences and addresses parental concerns not to randomise prior to oral switch criteria being met.FundingThe National Institute for Health Research Health Technology Assessment programme.
15
Fontalis, A., K. Hughes, M. P. Nguyen, M. Williamson, A. Yeo, D. Lui, and Y. Gelfer. "The challenge of differentiating vaso-occlusive crises from osteomyelitis in children with sickle cell disease and bone pain: A 15-year retrospective review." Journal of Children's Orthopaedics 13, no. 1 (February 2019): 33–39. http://dx.doi.org/10.1302/1863-2548.12.180094.
Full textAbstract:
Purpose The paediatric sickle cell disease (SCD) osteomyelitis (OM) incidence is 0.3% to 12%. Differentiating vaso-occlusive crises (VOC) from OM is a diagnostic challenge, with limited evidence guiding management. We present a 15-year review of a paediatric sickle cell cohort. We aim to identify OM incidence and provide a management protocol for these children presenting with bone pain. Methods A prospective database of children with haemoglobinopathies (2002 to 2017) was analyzed for temperature, C-reactive protein (CRP) and white cell count (WCC) on admission as well as imaging, treatment and cultures. OM diagnosis was supported by imaging and blood cultures. VOC was defined as bone pain that improved without antibiotics. Results Over 15 years, 96 children with SCD presented 358 times to hospital. Empirical antibiotics were given in 308 presentations. There were five cases of OM (1.4%); two acute and three chronic. In all, 50 presentations of VOC were identified. No significant differences in age were noted between the OM and VOC group. Temperature and CRP were significantly elevated in the OM group with no significant difference in WCC. Cultures were only positive in the chronic OM admissions. There were no cases of septic arthritis. No surgical intervention was required. Conclusion In children with SCD presenting with persistent bone pain, fever, elevated CRP and WCC, OM should be suspected and prompt antibiotic treatment started. Our treatment pathway was successful avoiding OM in 98.6% and septic arthritis in 100%. Further research on novel biological markers distinguishing OM from VOC should be investigated. Level of Evidence III
16
Doktor, Katherine L., Kelsey Heffernan, Danielle Drames, and Dana D. Byrne. "1419. A Rare Case of Clostridium beijerinckii Traumatic Osteomyelitis." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S517. http://dx.doi.org/10.1093/ofid/ofz360.1283.
Full textAbstract:
Abstract Background We present a case of Clostridium beijerinckii osteomyelitis in the presence of retained foreign bodies not seen on MRI. Methods A 45-year-old female with type 2 diabetes sustained multiple open right leg injuries, grossly contaminated with gravel, after a motor vehicle collision. She underwent external fixation (ex-fix) and 5 irrigations and debridements (I&D) initially. Polymicrobial intraoperative cultures (Cx) were treated with vancomycin and ertapenem for 6 weeks. One month post-antibiotic completion, pain, and swelling developed in ankle; contrast MRI revealed avascular necrosis and osteomyelitis (OM) of talus. Cx from repeat I&D grew same organisms; meropenem was recommended for 6 weeks. During meropenem week 6, pain was minimal and wound was closed. During attempt to implant hardware, pus was seen around peroneal tendon. Cx grew Clostridium species and Bacteroides from tibia, calcaneus, talus, and peroneal tendon sheath; meropenem was continued. Pain worsened 3 weeks later; I&D revealed pus in lateral ankle. To better access the medial ankle, a longitudinal incision was made along posterior tibial tendon, perpendicular to prior surgical incision. Immediate purulence, grass blades, and rocks were seen. Brucella agar had a rare gray colony at 48 hours and was subbed to blood and Brucella agar; it grew on Brucella agar with aero tolerance test. Gram stain showed Gram-positive rods with subterminal spores. Rapid ANA panel identified isolate as Clostridium beijerinckii (Cb) with > 99.9% probability and bioscore 1/24. Results Cb is a strict anaerobic gram-positive rod with oval subterminal spores. Found in soil and water, its main use is industrial solvent production. Infection by Cb is rare; only 2 cases of OM, 1 traumatic endophthalmitis, and 1 mitral valve endocarditis have been reported. While uncommon, Clostridial osteomyelitis is associated with contaminated open traumatic injuries. It can be difficult to eradicate, despite aggressive surgical intervention and appropriate antibiotics. Conclusion This is the third case of Cb OM described. Anaerobic cultures should be collected during I&D of open traumatic wounds. If infection persists, careful intraoperative evaluation of wound for residual foreign bodies, even if not seen radiologically, should be performed. Disclosures All authors: No reported disclosures.
17
Babushkina, Yu V., E. P. Burleva, F. V. Galimzyanov, and E. Yu Levchik. "Features of specialized care for patients with diabetic osteoarthropathy." Wounds and wound infections. The prof. B.M. Kostyuchenok journal 6, no. 2 (December 2, 2019): 6–16. http://dx.doi.org/10.25199/2408-9613-2019-6-2-6-16.
Full textAbstract:
Objective: to evaluate the results of specialized treatment of uncomplicated and complicated trophic ulcer (TU) and osteomyelitis (OM) of diabetic osteoarthropathy (DOAP).Materials and methods. The results of treatment in 114 patients (127 feet) with DOAP were analyzed: There were 52 (45.6 %) men, 62 (54.4 %) women. The type 1 diabetes mellitus (DM) was diagnosed in 36 (31.6 %) patients (average age 43.0 years old); type 2 diabetes – in 78 (68.4 %) people (average age – 58.0 years old). The acute and subacute stages of DOAP were detected in 55.9 % of cases, chronic – in 44.1 % of cases. The defeat of the middle part of the foot prevailed in 66.9 % of cases. Patients are ranked by the University of Texas classification. DOAP without TU – 71 (55.9 %) cases, with TU – 56 (44.1 %) observations. Stage BIII (OM) – 22 (17.3 %) cases: 8 (6.2 %) – in the subacute stage of DOAP, 14 (11.2 %) – in the chronic stage of DOAP. The examination protocol for DOAP included clinical data (+ sounding of the adjacent bone in TU), thermometry, radiography, and magnetic resonance imaging (MRI) of the feet, as well as laboratory data. A diagnostic algorithm has been developed for the optimal choice of tactical decisions in case of DOAP (TU–/OM–) and DOAP (TU+/OM+).Results. 80 patients were treated on an outpatient basis under the supervision of a podiatrist. Patients with acute or subacute DOAP (TU−/OM−) received conservative treatment in the form of unloading the limb using an individual discharge bandage until the transition to the chronic stage. In the chronic stage of DOAP (TU–/OM–) recommended the manufacture of complex orthopedic shoes for an individual block. In addition to the correction of hyperglycemia, patients with DOAP (TU+) (AI, AII, BI) used local treatment in accordance with the stage of the wound process. 34 patients (BII, BIII) were treated in a hospital. 27 patients of these underwent surgical procedures, osteonecrectomy, 7 patients underwent arthrodesis. All patients with DOAP (TU–/OM–) (n = 71) limb saved. With DOAP (TU+/OM+) (n = 56): 8 (14.3 %) people – the result is unknown, 7 (12.5 %) patients – retention of TU, 35 (62.5 %) patients – complete epithelization, 2 (3.6 %) cases – small amputations, 4 (7.2 %) – high amputations.Conclusion. Differentiated specialized treatment of uncomplicated and complicated by trophic ulcers or osteomyelitis DOAP in its various clinical stages made it possible to avoid high amputation in 96.6 % of cases.
18
Chan, James K. K., Jamie Y. Ferguson, Matthew Scarborough, Martin A. McNally, and Alex J. Ramsden. "Management of Post-Traumatic Osteomyelitis in the Lower Limb: Current State of the Art." Indian Journal of Plastic Surgery 52, no. 01 (January 2019): 062–72. http://dx.doi.org/10.1055/s-0039-1687920.
Full textAbstract:
AbstractOsteomyelitis (OM) of the lower limb represents a large unmet global healthcare burden. It often arises from a contiguous focus of infection and is a recognized complication of open fractures or their surgical treatment, arthroplasty, and diabetic foot ulcers. Historically, this debilitating condition is associated with high rates of recurrence and secondary amputation. However, excellent long-term outcomes are now achieved by adopting a multidisciplinary approach with meticulous surgical debridement, skeletal and soft tissue reconstruction, and tailored antimicrobial treatment. This review focuses on the modern evidence-based management of post-traumatic OM in the lower limb from a reconstructive plastic surgery perspective, highlighting the latest developments and areas of controversy.
19
TSCHERNING. "Om Fjärnelse af Benmarven som primär Behandling for den akute infektiöse osteomyelitis." Nordiskt Medicinskt Arkiv 19, no. 2 (April 24, 2009): 1–21. http://dx.doi.org/10.1111/j.0954-6820.1887.tb00869.x.
Full text
20
Petronglo, Jenna Rose, Nicole Putnam, Caleb Ford, Jacob Curry, and Jim Cassat. "The role of Toll-like receptor 2 and 9 in osteoclast responses to Staphylococcus aureus osteomyelitis." Journal of Immunology 204, no. 1_Supplement (May 1, 2020): 148.26. http://dx.doi.org/10.4049/jimmunol.204.supp.148.26.
Full textAbstract:
Abstract Staphylococcus aureus is the most common etiology of bone inflammation, or, osteomyelitis (OM). During S. aureus OM, difficulty of treatment is compounded by dysregulation of skeletal homeostasis, which alters the differentiation and function of skeletal cells, namely bone-building osteoblasts and bone-resorbing osteoclasts (OCs), to favor bone loss. Altered cytokine milieu and skeletal cell sensing of bacterial components contribute to this process. In systemic infection, Toll-like receptor (TLR) 2 and TLR9 are critical to antistaphylococcal immunity. Thus, in this study, we sought to determine the importance of TLR2 and TLR9 to the host response to S. aureus OM and to concomitant bone loss. Using in vitro assays, we discovered that S. aureus-induced OC differentiation proceeds in a TLR2-and TLR9-dependent manner. To confirm these findings in vivo, we surgically induced S. aureus OM in Tlr2−/− and Tlr9−/− mice. Despite increased mortality in Myd88−/− mice, we found TLR2 and TLR9 to be individually dispensable during S. aureus OM, with no difference in bacterial burdens nor in trabecular bone loss in femurs post-infection. Overall, our data suggest that redundancy in innate immune responses to S. aureus in bone renders TLR2 and 9 individually expendable in vivo. Because potentiation of these receptors in OCs may share compensatory downstream effects, we have begun in vivo experiments to examine bone loss and bacterial clearance in Tlr2/Tlr9−/− mice and in vitro assays to analyze S. aureus-induced cytokine production in Tlr2−/−, Tlr9−/−, and Tlr2/Tlr9−/− OCs. These findings support further studies into how bacterial stimulation and altered cytokine milieu contribute to dysregulated bone homeostasis during infection.
21
Afzelius, Pia, Aage Alstrup, Ole Nielsen, Karin Nielsen, and Svend Jensen. "Attempts to Target Staphylococcus aureus Induced Osteomyelitis Bone Lesions in a Juvenile Pig Model by Using Radiotracers." Molecules 25, no. 18 (September 21, 2020): 4329. http://dx.doi.org/10.3390/molecules25184329.
Full textAbstract:
Background [18F]FDG Positron Emission Tomography cannot differentiate between sterile inflammation and infection. Therefore, we, aimed to develop more specific radiotracers fitted for differentiation between sterile and septic infection to improve the diagnostic accuracy. Consequently, the clinicians can refine the treatment of, for example, prosthesis-related infection. Methods: We examined different target points; Staphylococcus aureus biofilm (68Ga-labeled DOTA-K-A9 and DOTA-GSGK-A11), bone remodeling ([18F]NaF), bacterial cell membranes ([68Ga]Ga-Ubiquicidin), and leukocyte trafficking ([68Ga]Ga-DOTA-Siglec-9). We compared them to the well-known glucose metabolism marker [18F]FDG, in a well-established juvenile S. aureus induced osteomyelitis (OM) pig model. Results: [18F]FDG accumulated in the OM lesions seven days after bacterial inoculation, but disappointingly we were not able to identify any tracer accumulation in OM with any of the supposedly more specific tracers. Conclusion: These negative results are, however, relevant to report as they may save other research groups from conducting the same animal experiments and provide a platform for developing and evaluating other new potential tracers or protocol instead.
22
Chen, Peisheng, Yinhuan Liu, Xiaofeng Lin, Bin Yu, Bin Chen, and Fengfei Lin. "The Underlying Molecular Basis and Mechanisms of Venous Thrombosis in Patients with Osteomyelitis: A Data-Driven Analysis." Genetics Research 2022 (June 6, 2022): 1–11. http://dx.doi.org/10.1155/2022/5672384.
Full textAbstract:
Objective. Osteomyelitis (OM) is one of the most risky and challenging diseases. Emerging evidence indicates OM is a risk factor for increasing incidence of venous thromboembolism (VTE) development. However, the mechanisms have not been intensively investigated. Methods. The OM-related dataset GSE30119 and VTE-related datasets GSE19151 and GSE48000 were downloaded from the Gene Expression Omnibus (GEO) database and analyzed to identify the differentially expressed genes (DEGs) (OMGs1 and VTEGs1, respectively). Functional enrichment analyses of Gene Ontology (GO) terms were performed. VTEGs2 and OMGs2 sharing the common GO biological process (GO-BP) ontology between OMGs1 and VTEGs1 were detected. The TRRUST database was used to identify the upstream transcription factors (TFs) that regulate VTEGs2 and OMGs2. The protein-protein interaction (PPI) network between VTEGs2 and OMGs2 was constructed using the Search Tool for the Retrieval of Interacting Genes (STRING) database and then visualized in Cytoscape. Topological properties of the PPI network were calculated by NetworkAnalyzer. The Molecular Complex Detection (MCODE) plugin was utilized to perform module analysis and choose the hub modules of the PPI network. Results. A total of 587 OMGs1 and 382 VTEGs1 were identified from the related dataset, respectively. GO-BP terms of OMGs1 and shared DGEs1 were mainly enriched in the neutrophil-related immune response process, and the shared GO-BP terms of OMGs1 and VTEGs1 seemed to be focused on cell activation, immune, defense, and inflammatory response to stress or biotic stimulus. 230 VTEGs2, 333 OMGs2, and 13 shared DEGs2 were detected. 3 TF-target gene pairs (SP1-LSP1, SPI1-FCGR1A, and STAT1-FCGR1A) were identified. The PPI network contained 1611 interactions among 467 nodes. The top 10 hub proteins were TP53, IL4, MPO, ELANE, FOS, CD86, HP, SOCS3, ICAM1, and SNRPG. Several core nodes (such as MPO, ELANE, and CAMP) were essential components of the neutrophil extracellular traps (NETs) network. Conclusion. This is the first data-mining study to explore shared signatures between OM and VTE by the integrated bioinformatic approach, which can help uncover potential biomarkers and therapeutic targets of OM-related VTE.
23
Parente, Raffaella, Valentina Possetti, Maria Lucia Schiavone, Elisabetta Campodoni, Ciro Menale, Mattia Loppini, Andrea Doni, et al. "3D Cocultures of Osteoblasts and Staphylococcus aureus on Biomimetic Bone Scaffolds as a Tool to Investigate the Host–Pathogen Interface in Osteomyelitis." Pathogens 10, no. 7 (July 3, 2021): 837. http://dx.doi.org/10.3390/pathogens10070837.
Full textAbstract:
Osteomyelitis (OM) is an infectious disease of the bone primarily caused by the opportunistic pathogen Staphylococcus aureus (SA). This Gram-positive bacterium has evolved a number of strategies to evade the immune response and subvert bone homeostasis, yet the underlying mechanisms remain poorly understood. OM has been modeled in vitro to challenge pathogenetic hypotheses in controlled conditions, thus providing guidance and support to animal experimentation. In this regard, traditional 2D models of OM inherently lack the spatial complexity of bone architecture. Three-dimensional models of the disease overcome this limitation; however, they poorly reproduce composition and texture of the natural bone. Here, we developed a new 3D model of OM based on cocultures of SA and murine osteoblastic MC3T3-E1 cells on magnesium-doped hydroxyapatite/collagen I (MgHA/Col) scaffolds that closely recapitulate the bone extracellular matrix. In this model, matrix-dependent effects were observed in proliferation, gene transcription, protein expression, and cell–matrix interactions both of the osteoblastic cell line and of bacterium. Additionally, these had distinct metabolic and gene expression profiles, compared to conventional 2D settings, when grown on MgHA/Col scaffolds in separate monocultures. Our study points to MgHA/Col scaffolds as biocompatible and bioactive matrices and provides a novel and close-to-physiology tool to address the pathogenetic mechanisms of OM at the host–pathogen interface.
24
Stumphauzer, Alex, Ryan P. Moenster, and Travis W. Linneman. "231. Retrospective Comparison of Intravenous Therapy, Oral Therapy, and Lipoglycopeptides for the Treatment of Osteomyelitis." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S225. http://dx.doi.org/10.1093/ofid/ofab466.433.
Full textAbstract:
Abstract Background The use of oral (PO) antibiotics and lipoglycopeptides are challenging the previous standard of osteomyelitis (OM) treatment, but there is currently a paucity of comparative data between these approaches. Methods This retrospective study included patients diagnosed with OM treated with intravenous (IV) antibiotics, PO antibiotics, or lipoglycopeptides between January 1, 2010 and June 1, 2020. Patients in the PO group could receive no more than 14 days of IV antibiotics prior to the PO course, and inclusion into the lipoglycopeptide group required at least 2 doses of drug to be administered. The primary outcome was occurrence of clinical failure within six months of completion of therapy, which was defined as new antibiotics or unplanned surgical intervention for an infection at the same site. Secondary outcomes included in-hospital length of stay (LOS), amputation within 6 months of therapy completion, and incidence of drug and line-related adverse effects. Previous osteomyelitis at index site, surgical intervention as a part of initial management, presence of Staphylococcus aureus on culture, utilization of outpatient parenteral antibiotic therapy (OPAT) services (IV group only), and concomitant PO therapy (lipoglycopeptide group only) were included in a bivariate analysis and variables with a p-value < 0.2 were included in a multivariate regression model. Results The IV group included 257 patients, while the PO and lipoglycopeptide groups included 20 and 15 patients respectively. In the IV group, 89 (35%) of the patients experienced clinical treatment failure compared to 5 (25%) in the PO group and 5 (33%) in the lipoglycopeptide group (p=0.71). Median LOS was significantly shorter in the PO group compared to the IV and LGP groups [1 day (IQR 0-2.5) vs. 7 days (IQR 4-10) and 4 days (IQR 4-9), p=0.003]. No difference between groups was observed for amputation within 6 months or incidence of adverse effects. The only variable included in the multivariate regression model was previous osteomyelitis at index site [OR 1.75, 95% CI (1.07 – 2.87)]. Conclusion PO and lipoglycopeptide therapy resulted in similar outcomes compared to IV antibiotics. Only previous OM at the same site was identified as an independent risk factor for failure. Disclosures Ryan P. Moenster, Pharm.D., FIDSA, AbbVie (Speaker’s Bureau)Melinta (Consultant, Speaker’s Bureau)
25
Heinisch, M., P. Mikosch, E. Kresnik, G. Kumnig, I. Gomez, P. Lind, and H. J. Gallowitsch. "Tc-99m ciprofloxacin in clinically selected patients suspected for peripherial osteomyelitis, spondylodiscitis and fever of unknown origin: preliminary results." Nuklearmedizin 41, no. 01 (2002): 30–36. http://dx.doi.org/10.1055/s-0038-1623999.
Full textAbstract:
Summary Aim: Retrospective evaluation of Tc-99m ciprofloxacin (infecton) scintigraphy consecutively performed in a series of patients clinically suspected for peripheral osteomyelitis (OM), spondylodiscitis (SD) and fever of unknown origin (FUO). Methods: A total of 20 patients clinically suspected for OM (n = 12), SD (n = 3) and FUO (n = 5) were included in our retrospective analysis. The additional criterion was a positive 3-phase bone scan for OM, or a 2-phase bone scan in case of SD. Planar whole body scans and static acquisitions were performed 1 and 4 h after application of 370 MBq Tc-99m ciprofloxacin. In 10 patients with suspected OM, additional immunoscintigraphy using Tc-99m labelled monoclonal antibodies (Mab BW 250/183) was performed and the correlation of infecton to bloodpool and antigranulocyte scintigraphy was analysed. Results: OM: Bacterial infection was confirmed in 8 of 15 lesions. Infecton demonstrated true positive (TP) results in 7 of 8, true negative (TN) results in 2 of 7, false positive (FP) results in 5 of 7 patients and one false negative (FN) result. A strong correlation could be demonstrated between T/NT ratios of infecton and bloodpool Tc-99m medronate imaging (r = 0.84, 0.88) and between infecton and BW 250/183 (r = 0.92, 0.90). Using a threshold of 2.0 for T/NT ratio, only TP results could be observed whereas a T/NT in the range of 1.0-2.0 could not discriminate between septic and aseptic inflammation. Concordant results with Mab BW 250/183 could only be observed in 5 of 10 patients (4 TP, 1 TN) by showing 4 FP and 1 FN lesions with IF. Conclusion: Non-specific uptake of infecton can be observed in a variety of clinical situations with moderate uptake, by showing a strong correlation with blood-pool imaging. Nevertheless, intense uptake may be specific for septic inflammation.
26
Vivian, Frederik, and Subarna Chakravorty. "Plain film x-rays in the diagnosis of sickle cell limb pain in children." Physician 7, no. 1 (February 27, 2021): 1–6. http://dx.doi.org/10.38192/1.7.1.4.
Full textAbstract:
Background and aims: Children with sickle cell disease (SCD) frequently present with limb pain. Differentials include vaso-occlusive episode (VOE) and osteomyelitis (OM). X-rays expose to radiation but rarely aid in diagnosis. We audited the use of x-ray in investigating children with SCD presenting with limb pain to a South London hospital and analysed whether x-rays aid in diagnosis.
Methods: Patients aged 0-18 with SCD were identified using the hospital’s SCD database. Admissions from January 2010 to September 2019 in which limb pain was a documented symptom were included.
Results: Of 342 patients investigated, there were 188 admissions with limb pain. Diagnoses at discharge were: 174 VOE, 4 OM, and 7 others. 44 (25%) of those with VOE had limb x-rays, compared with 3 (75%) of those with OM. Of those x-rayed, 11 with VOE and all with OM had a subsequent MRI. None of the x-rays assisted in confirming the diagnosis or change management. Of the VOE patients, more of those that were x-rayed had swelling (48% vs 8%, p=<0.0001), and fevers (57% vs 37%, p=0.021), and peak CRP was higher (109 vs 75, p=0.044).
Conclusions: X-rays were frequently used to investigate children with SCD. Limb swelling, fevers and higher CRP, features potentially suggestive of OM, were more common in those that were x-rayed. X-rays did not aid in distinguishing VOE and OM or change management.
27
Hirschfeld, Cole, Shashi Kapadia, Joanna Bryan, Deanna Jannat-Khah, Benjamin May, Tamir Friedman, Ole Vielemeyer, and Ernie Esquivel. "Utility of Diagnostic Bone Biopsies in the Management of Osteomyelitis Through Retrospective Analysis: How Golden Is This Gold Standard?" Open Forum Infectious Diseases 4, suppl_1 (2017): S91. http://dx.doi.org/10.1093/ofid/ofx163.056.
Full textAbstract:
Abstract Background Bone biopsy is considered the gold standard for diagnosis and treatment of osteomyelitis (OM), but few studies have investigated the extent to which it influences antimicrobial therapy in non-vertebral bones. The purpose of this study was to evaluate clinician-initiated changes to empiric antimicrobial therapy after obtaining bone biopsy results. A secondary aim was to identify predictors of a positive bone culture. Methods We retrospectively reviewed all cases of non-vertebral OM in patients who underwent image-guided bone biopsies between 2009 and 2016. Data on pathologic and microbiologic yield were collected and logistic regression was used to determine potential factors affecting the microbiologic yield. Post-biopsy empiric antibiotics and final antibiotics were compared with determine if there was a change in antibiotic treatment after biopsy results were reported. Results We evaluated 203 bone biopsies in 185 patients. Samples from 115 (57%) cases were sent to pathology, of which 33 (29%) confirmed OM. All samples were sent to microbiology and 57 (28%) yielded a positive result. Diabetes (OR=2.39, P = 0.021) and white blood cell count (OR=1.13, P = 0.006) were significantly associated with positive bone cultures in multivariate analyses. There was no association between positive cultures and number of samples cultured, needle size, prior antibiotic use, or antibiotic-free days. Post-biopsy empiric antibiotics were given in 138 (68%) cases. Therapy was narrowed to target specific organisms in seven cases and changed due to inadequate empiric treatment in three cases. Targeted therapy was initiated in 4/65 cases, in which empiric antibiotics had been initially withheld. While final antibiotics were withheld in 38/146 with negative bone cultures, empiric antibiotics were discontinued in only eight cases. Conclusion In patients with non-vertebral OM, bone biopsy cultures rarely yielded results that necessitated changes in antibiotic management. Identified bone organisms were treated by empiric therapy in most patients. While bone biopsy remains the gold standard diagnostic test for OM, further work is needed to identify patients whose management may be impacted by this procedure. Disclosures All authors: No reported disclosures.
28
Tan, Xing, and Ryan P. Moenster. "Ceftolozane–tazobactam for the treatment of osteomyelitis caused by multidrug-resistant pathogens: a case series." Therapeutic Advances in Drug Safety 11 (January 2019): 204209861986208. http://dx.doi.org/10.1177/2042098619862083.
Full textAbstract:
Ceftolozane–tazobactam (CT) is a recently approved novel cephalosporin and β-lactamase inhibitor combination agent with in vitro activity against various Gram-positive and Gram-negative pathogens, including several multidrug-resistant (MDR) Gram-negative organisms. CT is currently approved by the US Food and Drug Administration for the treatment of complicated intrabdominal infection and complicated urinary tract infection at a dose of 1.5 g intravenously every 8 h. This agent is an attractive option for MDR osteomyelitis (OM) treatment, but clinical data is limited to case reports and series. Here we report a series of five patients with MDR OM who were treated with CT. Pathogens involved in these infections were MDR Acinetobacter baumannii (two isolates) and MDR Pseudomonas aeruginosa (four isolates). Two patients were disease free 6 months after therapy was discontinued, one required an additional curative surgical procedure, and two (both on high-dose therapy) developed adverse reactions likely related to CT that necessitated early antibiotic discontinuation.
29
Pearson, Christopher D., Dorothy Holzum, Ryan P. Moenster, and Travis W. Linneman. "1424. Association Between Erythrocyte Sedimentation Rate (ESR) Change and Treatment Failure in Patients with Osteomyelitis." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S519. http://dx.doi.org/10.1093/ofid/ofz360.1288.
Full textAbstract:
Abstract Background Erythrocyte sedimentation rate (ESR) is monitored during therapy for osteomyelitis (OM) but the degree of reduction associated with treatment success remains unclear. Methods This retrospective cohort study evaluated patients treated for at least 2 weeks with intravenous (IV) antibiotics for OM through the VA St. Louis HCS from 1 January 2010 to 1 January 2018 with at least 2 ESR values during their therapy. Patients were excluded if they had comorbidities that could cause elevations in ESR. The primary outcome was the rate of treatment failure in patients achieving ≥50% decrease in ESR from baseline compared with those without a 50% decrease. Treatment failure was defined as a need for unplanned surgical intervention or re-initiation of antibiotic therapy for OM of the same anatomical site within 6-months after initial therapy was discontinued. The presence of diabetes, peripheral vascular disease (PVD), age >70, baseline creatinine clearance (CrCl) < 50 mL/minute, surgical intervention as part of initial therapy, and ESR reduction ≥50% from baseline were included in a univariate analysis with variables with a P < 0.2 included in a multivariate logistic regression model. Results A total of 143 patients were included; 74 patients with a ≥50% decrease in ESR and 69 patients with a decrease <50%. Mean initial ESRs were not different between groups (79.5±31 vs. 79.9 ± 32 mm/hour, P = 0.95), but end-of-treatment values were significantly higher in the <50% reduction group vs. ≥50% (20.6 ± 14 vs. 72.4 ± 42 mm/hour, P < 0.05, respectively). There were no baseline differences between groups in regards to age, rates of diabetes, PVD, CrCl < 50 mL/minute, initial surgical therapy management, or definitive vs. empiric therapy. Thirty percent (22/74) of patients with a ≥50% reduction in ESR failed treatment vs. 55% (38/69) in patients with a <50% reduction (P < 0.01). Only ESR reduction of ≥50% met criteria for inclusion in the multivariate regression model and was associated with a 65.5% relative risk reduction in treatment failure (OR 0.345; 95% CI 0.173–0.687; P = 0.002). Conclusion Achieving an ESR reduction of ≥50% from baseline during treatment for OM was independently associated with a significant reduction in risk of treatment failure. Disclosures All authors: No reported disclosures.
30
Hung, G., C. A. Stewart, F. Sapico, R. Chambers, J. Montgomerie, and A. Bessman. "Tc-99m ANTIGRANULOCYTE ANTIBODY IN THE EVALUATION OSTEOMYELITIS (OM) IN PATIENTS WITH FOOT ULCERS." Clinical Nuclear Medicine 20, no. 9 (September 1995): 859. http://dx.doi.org/10.1097/00003072-199509000-00053.
Full text
31
Nguyen, Thinh, Sudheer Surpure, and Leonor Echevarria. "233. Osteomyelitis of the jaw: A retrospective analysis of clinical, microbiologic characteristics and antimicrobial treatment at a Tertiary Care Medical Center." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S226. http://dx.doi.org/10.1093/ofid/ofab466.435.
Full textAbstract:
Abstract Background Osteomyelitis of the jaw is a relatively rare entity in the post antibiotic era. The aim of this study is to describe clinical characteristics, microbiology and antibiotics use (oral vs intravenous) for treatment. We review 5 years of experience at Banner University Medical Center-Phoenix (BUMC-P) of proven cases of OM jaw by clinical, pathological, radiological criteria. Methods Retrospective study of cases. From January 2011 to November 2015 ,157 cases of osteomyelitis of the jaw, we excluded cases of radiation therapy or neoplasia to the head and neck region, a history of antiresorptive medication use. A total of 34 patients with diagnosis of osteomyelitis of the jaw were reviewed. All patients met criteria for diagnosis of osteomyelitis and underwent surgical debridement and received antibiotics that included parenteral, orals and combined. We reviewed clinical, microbiology, antibiotic use. A successful outcome was defined as elimination of clinical symptoms, restoration of function and if available radiographic evidence of arrest and resolution of bony necrosis. Results This retrospective study involved 34 patients. Most common organisms were oropharyngeal flora 22 samples (65%): streptococcus anginosus group. 4 samples grew unusual gram negative bacteria. 10 (29%) samples grew fungal species. Antimicrobial regimen was divided in: intravenous (n=14) (41.2%), oral (n=7) (20.6%) and combination intravenous followed by orals as follows: 13 (38.2 %).The average antibiotic duration was 8.1 + 4.7 weeks. We were able to follow up 30 patients, average follow up was 32.1-44.7 weeks. The overall success rate was (n=24) 80% with uneventful healing and. (n=6) (20%) treatment failure. There was more failure in the oral antibiotics group (n=3). Conclusion This study is limited by small numbers. Surgery and cultures should guide treatment of osteomyelitis of the jaw. The use of oral antimicrobial therapy was associated to a higher likelihood of treatment failure. Although rarely linked as a cause of osteomyelitis, the authors think that the cultivation of candida spp should prompt appropriate coverage. More study is required to understand the efficacy of oral antimicrobial therapy in treating osteomyelitis of the jaw. Disclosures All Authors: No reported disclosures
32
Brown, Vanessa, Travis W. Linneman, and Ryan P. Moenster. "1553. Efficacy and Safety of Dalbavancin and Oritavancin in the Treatment of Gram-Positive Infections." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S777. http://dx.doi.org/10.1093/ofid/ofaa439.1733.
Full textAbstract:
Abstract Background Lipoglycopeptides are approved for acute bacterial skin and skin structure infections (ABSSSI), but are often used in other infections, including osteomyelitis (OM) and bloodstream infections (BSI). Methods This retrospective cohort study included VA St. Louis Health Care System patients aged ≥18 through ≤89 years treated for ABSSSI, BSI, or OM with lipoglycopeptides. Patients were excluded if they received ≥72 hours (ABSSSI, BSI) or ≥7 days (OM) of antibiotics prior to lipoglycopeptide administration or other intravenous antibiotics were administered for ≥48 hours after lipoglycopeptide. The primary efficacy outcome was clinical success in the lipoglycopeptide cohort, defined per infection. Secondary outcomes were a comparison of clinical success in the lipoglycopeptide cohort to historical controls of patients treated at the VA St. Louis for ABSSSI, BSI, or OM. A multivariate regression was also conducted to find factors in the lipoglycopeptide group independently associated with clinical success. Safety outcomes compared adverse drug reactions between single- and 2-dose regimens of lipoglycopeptides. Results A total of 36 patients were included in the analysis; no patients met inclusion for bloodstream infection. Twenty-nine patients were treated for ABSSSI and 7 patients met inclusion for OM treatment. Dalbavancin was the agent used most often for both OM (4/7) and ABSSSI (22/29). The primary outcome of clinical success occurred in 77.7% (28/36) of the lipoglycopeptide cohort. There was no difference in clinical success between the lipoglycopeptide cohort and historical controls for ABSSSI (86% [5/29] vs 84% [159/189], p >0.05) or OM (43% [3/7] vs 58% [83/143], p >0.05). No difference in adverse outcomes between single- and 2-dose regimens of lipoglycopeptide were observed. Conclusion Clinical success for patients treated with lipoglycopeptides for ABSSSI and OM in this small cohort were comparable to historical controls. No difference was identified in the safety between single- and 2-dose regimens of lipoglycopeptides. Disclosures All Authors: No reported disclosures
33
Holzum, Dorothy, Christopher D. Pearson, Ryan P. Moenster, Travis W. Linneman, and Jonathan McMahan. "1431. Comparison of Treatment Outcomes with Definitive Antibiotic Therapy and Empiric Antibiotic Therapy in Osteomyelitis." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S522. http://dx.doi.org/10.1093/ofid/ofz360.1295.
Full textAbstract:
Abstract Background Definitive therapy for osteomyelitis (OM) is thought to be superior to empiric antimicrobial therapy; however, identifying causative pathogens is difficult. Methods This retrospective cohort study included patients treated with either definitive or empiric antimicrobial therapy for OM at VA St. Louis HCS between 1 January 2010 and 1 January 2018. Definitive antibiotic therapy was defined as a regimen tailored to susceptibilities of an organism(s) cultured from bone or deep tissue. The primary outcome was treatment failure, defined as a need for unplanned surgical intervention or re-initiation of antibiotic therapy for OM of the same anatomical site within 6-months after initial therapy was discontinued. Secondary outcomes included the incidence of acute kidney injury (AKI), Clostridium difficile-associated diarrhea (CDAD), and thrombocytopenia. Surgical intervention as part of initial therapy, presence of peripheral vascular disease (PVD), creatinine clearance < 50 mL/minute at initiation of therapy, receiving antibiotics at an extended care facility, age > 60 years, and receiving definitive antibiotics were included in a univariate analysis with variables with a P < 0.2 included in a multivariate logistic regression. Results There were 301 patients included; 179 in the definitive therapy group and 122 in the empiric therapy group. Baseline characteristics were similar among groups; however, more patients receiving definitive therapy had a bone biopsy compared with those treated with empiric therapy (58.1% (104/179) vs. 36.8% (45/122); P < 0.05). 33 percent (60/179) of patient treated with definitive therapy failed compared with 45% (55/122) treated with empiric therapy (P = 0.109). No significant differences were observed in secondary outcomes; however non-CDAD diarrhea occurred more in the empiric therapy group than definitive therapy group (3.9% (7/179) vs. 8.2% (10/122); P > 0.05). Receiving definitive therapy (OR 1.43, CI 0.89–2.313; P = 0.138) and presence of PVD (OR 1.34; CI 0.823–2.197; P = 0.238) were included in the multivariate logistic regression, but neither were independently associated with failure. Conclusion Definitive antibiotic therapy was not associated with a significant decrease in treatment failure. Disclosures All authors: No reported disclosures.
34
Liu, Guan-qiao, Nan Jiang, Yan-jun Hu, Qing-rong Lin, Lei Wang, and Bin Yu. "Serum Calcium Level Combined with Platelet Count May Be Useful Indicators for Assisted Diagnosis of Extremity Posttraumatic Osteomyelitis: A Comparative Analysis." Disease Markers 2021 (October 28, 2021): 1–7. http://dx.doi.org/10.1155/2021/6196663.
Full textAbstract:
Background. A previous study had reported that patients with osteomyelitis (OM) appeared to be more likely to develop hypocalcemia before and after surgery. Calcium sulfate (CS) is frequently used as a local antibiotic vehicle in the treatment of OM, which may also affect serum calcium level. However, whether changes of serum calcium level are caused by OM and/or local use of calcium sulfate remains unclear. Also, platelet (PLT) count plays a crucial predictive role in periprosthetic joint infections (PJIs), but its role in assisted diagnosis of OM is largely unknown. The purpose of this study was to determine whether serum calcium level and PLT count may be helpful in assisted diagnosis of PTOM. Methods. Between January 2013 and December 2018, we analyzed 468 consecutive patients (392 males and 76 females), including 170 patients with posttraumatic OM (PTOM), 130 patients with aseptic bone nonunion (ABN), and 168 patients recovered from fractures with requirement of implant removal set as controls. Preoperative serological levels of calcium, phosphorus, and PLT were detected, and comparisons were conducted among the above three groups. Additionally, correlations and receiver operating characteristic (ROC) curves were displayed to test whether calcium level and PLT can differentiate patients with ABN and PTOM. Results. Outcomes showed that the incidences of asymptomatic hypocalcemia (PTOM vs. ABN vs. controls = 22.94 % vs. 6.92% vs. 8.82%, χ 2 = 21.098 , P < 0.001 ) and thrombocytosis (PTOM vs. ABN vs. controls = 35.3 % vs. 13.84% vs. 12.35%, χ 2 = 28.512 , P < 0.001 ) were highest in PTOM patients. Besides, the mean serological levels of phosphorus in PTOM and ABN patients were significantly higher than those in the controls ( P = 0.007 ). The Area Under the Curve (AUC) of the ROC curve outcomes revealed that, with the combination of serum calcium level with PLT count, the predictive role was acceptable (AUC 0.730, P < 0.001 , 95% CI 0.681-0.780). Also, serological levels of calcium of 2.225 mmol/L and PLT count of 246.5 × 10 9 / L were identified as the optimal cut-off values to distinguish patients with and without PTOM. However, age- and gender-related differences in serum calcium levels (age, P = 0.056 ; gender, P = 0.978 ) and PLT count (age, P = 0.363 ; gender, P = 0.799 ) were not found to be statistically significant in any groups. In addition, no significant correlations were identified between serum calcium level and PLT count ( R = 0.010 , P = 0.839 ). Conclusions. Asymptomatic hypocalcemia and thrombocytosis appeared to be more frequent in this cohort with PTOM. Serological levels of calcium and PLT count may be useful biomarkers in screening patients suspected of PTOM.
35
Jiang, Nan, Guan-qiao Liu, Jia-jun Yang, Qing-rong Lin, Yan-jun Hu, and Bin Yu. "Is Hypercalcemia a Frequent Complication following Local Use of Calcium Sulfate with Antibiotics for the Treatment of Extremity Posttraumatic Osteomyelitis? A Preliminary Study." BioMed Research International 2019 (March 31, 2019): 1–7. http://dx.doi.org/10.1155/2019/7315486.
Full textAbstract:
Background. Previous study had reported hypercalcemia as a frequent complication (20%) following local use of antibiotic-eluting calcium sulfate (CS) during treatment of periprosthetic joint infections (PJIs). However, whether this complication may occur in patients who receive local CS implantation for management of posttraumatic osteomyelitis (OM) remains unclear. Methods. Between April 2016 and May 2017, we included 55 patients with extremity posttraumatic OM who received local antibiotic-loaded CS therapy. Serum calcium levels were detected preoperatively and on the 1st, 3rd, and 7th postoperative days (PODs). Comparisons were performed regarding serum calcium levels among the four time points and between two different CS volume groups (≤ 20 cc group and > 20 cc group). Additionally, potential associations were examined regarding CS volume and preoperative calcium level with postoperative calcium levels, respectively. Results. Altogether 46 males and 9 females were included, with a median CS volume of 20 cc. Outcomes showed that prevalence of asymptomatic hypocalcemia was more frequent, with 16.4% before surgery and 60%, 53.8%, and 25% on the 1st, 3rd, and 7th PODs, respectively. Hypercalcemia was not found in any patients, at any time point. In addition, significant differences were identified regarding serum calcium levels among different time points, suggesting significantly decreased calcium levels on the 1st (P < 0.001) and 3rd PODs (P < 0.001) and back to near preoperative level on the 7th POD (P = 0.334). However, no statistical differences were observed regarding serum calcium levels between the two CS volume groups at any time points (P > 0.05). Moreover, no significant links were identified between CS volume and postoperative calcium levels (P > 0.05). Serum calcium levels on the 3rd (P = 0.019) and 7th PODs (P = 0.036) were significantly associated with the preoperative calcium level. Conclusions. In contrast to what had occurred in PJI patients, asymptomatic hypocalcemia appeared to be more frequent in this cohort with posttraumatic OM. Hypercalcemia may be an infrequent complication before and after local CS use for the treatment of extremity posttraumatic OM.
36
Trivellas, Andromahi, Dane Brodke, Vivian Hu, Annabelle de St Maurice, Paul Krogstad, Mauricio Silva, and Rachel M. Thompson. "The utility of echocardiography in paediatric patients with musculoskeletal infections and bacteremia." Journal of Children's Orthopaedics 15, no. 6 (December 1, 2021): 577–82. http://dx.doi.org/10.1302/1863-2548.15.210110.
Full textAbstract:
Purpose The clinical utility of echocardiography in the setting of a positive blood culture in paediatric patients presenting with osteomyelitis (OM) and/or septic arthritis (SA). Methods Retrospective review between 2013 and 2019: Patients < 18 years with OM, SA or combined infection (OM+SA) were included. Patients were excluded for immunodeficiency, loss of follow-up or penetrating infection. Charts with positive blood cultures were reviewed for echocardiography on that admission. Demographic variables were compared utilizing the Student’s t-test and Fisher’s exact test. A multivariable linear regression model was constructed to examine the association between echocardiography and length of stay, controlling for age, sex, fever, white blood cell (WBC) on admission, antibiotic administration and surgery performed. Results Of 157 patients with OM, SA or combined infection, 44 had a positive blood culture. In all, 26 had an echocardiogram, and none showed endocarditis. Echocardiography was independently associated with a 6.2-day length of stay increase. WBC count and surgical intervention demonstrated a trend toward significance in length of stay, with each WBC unit increase associated with a 0.53-day increase. Surgical intervention was associated with an average 6.3-day length of stay decrease. Conclusion No patient had a positive echocardiogram, and no changes in management were initiated. However, an echocardiogram increased stay by 6.2 days. In addition to costs associated with increased stay, patients were billed between $1460 and $1700 per echocardiogram. The utility of echocardiograms in the setting of bacteremia associated with musculoskeletal infections in the paediatric population should be re-examined, and guidelines should be updated to reflect the cost-benefit analysis. Level of Evidence: III
37
Lauri, Chiara, Andor W. J. M. Glaudemans, Giuseppe Campagna, Zohar Keidar, Marina Muchnik Kurash, Stamata Georga, Georgios Arsos, et al. "Comparison of White Blood Cell Scintigraphy, FDG PET/CT and MRI in Suspected Diabetic Foot Infection: Results of a Large Retrospective Multicenter Study." Journal of Clinical Medicine 9, no. 6 (May 30, 2020): 1645. http://dx.doi.org/10.3390/jcm9061645.
Full textAbstract:
Diabetic foot infections (DFIs) represent one of the most frequent and disabling morbidities of longstanding diabetes; therefore, early diagnosis is mandatory. The aim of this multicenter retrospective study was to compare the diagnostic accuracy of white blood cell scintigraphy (WBC), 18F-fluorodeoxyglucose positron emission tomography/computed tomography ((18F) FDG PET/CT), and Magnetic Resonance Imaging (MRI) in patients with suspected DFI. Images and clinical data from 251 patients enrolled by five centers were collected in order to calculate the sensitivity, specificity, and accuracy of WBC, FDG, and MRI in diagnosing osteomyelitis (OM), soft-tissue infection (STI), and Charcot osteoarthropathy. In OM, WBC acquired following the European Society of Nuclear Medicine (EANM) guidelines was more specific and accurate than MRI (91.9% vs. 70.7%, p < 0.0001 and 86.2% vs. 67.1%, p = 0.003, respectively). In STI, both FDG and WBC achieved a significantly higher specificity than MRI (97.9% and 95.7% vs. 83.6%, p = 0.04 and p = 0.018, respectively). In Charcot, both MRI and WBC demonstrated a significantly higher specificity and accuracy than FDG (88.2% and 89.3% vs. 62.5%, p = 0.0009; 80.3% and 87.9% vs. 62.1%, p < 0.02, respectively). Moreover, in Charcot, WBC was more specific than MRI (89.3% vs. 88.2% p < 0.0001). Given the limitations of a retrospective study, WBC using EANM guidelines was shown to be the most reliable imaging modality to differentiate between OM, STI, and Charcot in patients with suspected DFI.
38
Singh, V. B., Rahul Kunder, Dinesh Kumar, Vipin Mishra, and P. K. Lakhtakiya. "AN OBSERVATIONAL COMPARATIVE STUDY OF CRP AND ESR IN EVALUATION AND MANAGEMENT OF ACUTE BONE AND JOINT INFECTION IN PEDIATRIC PATIENTS IN TERTIARY CARE CENTRE OF CENTRAL INDIA." International Journal of Advanced Research 9, no. 02 (February 28, 2021): 681–86. http://dx.doi.org/10.21474/ijar01/12498.
Full textAbstract:
Introduction :Acute osteomyelitis of childhood usually affects the long bones of the lower limbs. Although almost any agent may cause acute osteomyelitis, Staphylococcus aureus is the most common bacteria. We conducted a prospective and observational study from July 2019-January 2021. Aims and Objects: Our studyincluded 36 children between the ages of 5 months and 14 years, with suspected acute osteoarticular infection, with a predetermined seriesof ESR, CRP measurements. Material and Methods:We included 36 patients in our study out of which 25 patient had a diagnosis of acute osteomyelitis (70%) and 11 patient had acuteseptic arthritis(SA) (30%). Boyswere predominantly affected (64% boys as compared to 36 % girls), and the mean age was 6.12 years. Theaverage ESR on day of admission, 3rd, 10th, one month and two month was 36 mm, 51 mm, 37mm, 20mm and 14 mm at one hour respectively.Average CRP on day of admission, 3rd, 10th, one month and two month was 86 mg/l, 64mg/l, 19.6mg/l, 10mg/l, 5mg/l respectively. Results: Theobserved peaks of the ESR reached on day 3 and peak in CRP titre generally was seen on day of admission .After peaking, ESR started a slowdescent the <20-mm/hour level was reached on end of one month. CRP started a more rapid normalization, descending to less than 20 mg/L in 10 days.CRP normalizes faster than ESR, providing a clear advantage in monitoring recovery. CRP normalized earlier in patients with OM, where as normalization was slower in patients with SA. Conclusion: Serial measurements of ESR and CRP not only help in diagnosing Acute boneand joint infections in children but also help in monitoring response to treatment and duration of antibiotics.
39
Gupta, Amit, Aditya Menon, Camilla Rodrigues, Ayesha Sunavala, and Vikas Agashe. "Second Ray Amputation in Diabetic Foot – Functionally Better than Proximal Foot Amputations, but Beware of Charcot Arthropathy: A Case Report and Review of Literature." Journal of Orthopaedic Case Reports 12, no. 3 (2022): 13–17. http://dx.doi.org/10.13107/jocr.2022.v12.i03.2696.
Full textAbstract:
Introduction:Lower limb amputations secondary to diabetic foot infection/osteomyelitis (OM) are the most common cause for non-traumatic amputations of the lower extremity. Hind/midfoot amputations are commonly done for metatarsal (MT) OM. They are, however, associated with higher complication and revision rates and often lead to below knee amputation. In comparison, distal/forefoot toe disarticulation/ray amputation (R amp) have lesser revision rates/complications and give better functional outcome. Here, we report a case of 2nd R amp with an uncommon complication. Case Report:A 42-year-old male with uncontrolled diabetes and bilateral diabetic neuropathy presented with discharging sinus over plantar aspect of the left foot since 1 week. There was no evidence of underlying OM on MRI. Wound healed with soft-tissue debridement and empirical antibiotics (culture negative) for 2 weeks. Re-debridement was done for a wound gape 6 weeks later. Infection resolved with targeted antibiotics (oral ciprofloxacin and doxycycline) for Enterobacter cloacae given for 1 month. Six months later, he developed pain and swelling in the left foot following prolonged barefoot walking and possible injury with a stone. There was local redness, swelling, and a plantar sinus. MRI revealed septic arthritis of the left 2nd metatarsophalangeal (MTP) joint, OM of the 2nd MT head, and an encapsulated soft-tissue abscess. Aggressive debridement with 2nd R amp and careful separation of encapsulated abscess was done leaving behind base of 2nd MT to maintain stability of the Lisfranc joint. Wound healed primarily. Targeted antibiotics for Methicillin Susceptible Staphylococcus aureus were given for 6 weeks. Good diabetic control and avoiding bare foot walking were advised and he is infection free, fully functional, and asymptomatic at 36 months. However, he was noted to have developed valgus deformity of the midfoot secondary to Charcot osteoarthropathy of the Lisfranc joints at 36 months follow-up, involving 1st, 3rd, and 4th TMT joints. The other foot did not show any evidence of Charcot arthropathy. Conclusion:Recurrent wound infections with subsequent OM are a common feature of diabetic foot. R amps have better functional outcomes with preserved foot stability, shorter length of hospitalization, and associated costs as compared to hind/midfoot amputations. They may, however, develop Charcot osteoarthropathy due to the void between adjoining MTs resulting in altered forces across the Lisfranc joints. Surgeons must beware of this complication, especially following R amps and monitor these patients with serial clinical and radiographic examination.
40
Rubitschung, Katie, Amber Sherwood, Andrew P. Crisologo, Kavita Bhavan, Robert W. Haley, Dane K. Wukich, Laila Castellino, et al. "Pathophysiology and Molecular Imaging of Diabetic Foot Infections." International Journal of Molecular Sciences 22, no. 21 (October 26, 2021): 11552. http://dx.doi.org/10.3390/ijms222111552.
Full textAbstract:
Diabetic foot infection is the leading cause of non-traumatic lower limb amputations worldwide. In addition, diabetes mellitus and sequela of the disease are increasing in prevalence. In 2017, 9.4% of Americans were diagnosed with diabetes mellitus (DM). The growing pervasiveness and financial implications of diabetic foot infection (DFI) indicate an acute need for improved clinical assessment and treatment. Complex pathophysiology and suboptimal specificity of current non-invasive imaging modalities have made diagnosis and treatment response challenging. Current anatomical and molecular clinical imaging strategies have mainly targeted the host’s immune responses rather than the unique metabolism of the invading microorganism. Advances in imaging have the potential to reduce the impact of these problems and improve the assessment of DFI, particularly in distinguishing infection of soft tissue alone from osteomyelitis (OM). This review presents a summary of the known pathophysiology of DFI, the molecular basis of current and emerging diagnostic imaging techniques, and the mechanistic links of these imaging techniques to the pathophysiology of diabetic foot infections.
41
Lauri, Chiara, Antonio Leone, Marco Cavallini, Alberto Signore, Laura Giurato, and Luigi Uccioli. "Diabetic Foot Infections: The Diagnostic Challenges." Journal of Clinical Medicine 9, no. 6 (June 8, 2020): 1779. http://dx.doi.org/10.3390/jcm9061779.
Full textAbstract:
Diabetic foot infections (DFIs) are severe complications of long-standing diabetes, and they represent a diagnostic challenge, since the differentiation between osteomyelitis (OM), soft tissue infection (STI), and Charcot’s osteoarthropathy is very difficult to achieve. Nevertheless, such differential diagnosis is mandatory in order to plan the most appropriate treatment for the patient. The isolation of the pathogen from bone or soft tissues is still the gold standard for diagnosis; however, it would be desirable to have a non-invasive test that is able to detect, localize, and evaluate the extent of the infection with high accuracy. A multidisciplinary approach is the key for the correct management of diabetic patients dealing with infective complications, but at the moment, no definite diagnostic flow charts still exist. This review aims at providing an overview on multimodality imaging for the diagnosis of DFI and to address evidence-based answers to the clinicians when they appeal to radiologists or nuclear medicine (NM) physicians for studying their patients.
42
Mays, Erin, Alan C. Kinlaw, Michael J. Swartwood, Renae A. Boerneke, Claire E. Farel, and Ashley Marx. "743. Evaluation of Adverse Drug Reactions due to Common β-Lactam Therapies Among Patients Enrolled in an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S332. http://dx.doi.org/10.1093/ofid/ofz360.811.
Full textAbstract:
Abstract Background The UNC Medical Center Outpatient Parenteral Antimicrobial Therapy (OPAT) program was started in 2015 to provide multidisciplinary monitoring and management of patients discharged on parenteral antimicrobials. Laboratory abnormalities and adverse drug reactions (ADRs) are potential complications of OPAT that may result in readmission and treatment changes. The purpose of this study was to evaluate the time to first ADR for OPAT patients treated with BL therapies for diabetic foot infections (DFI) and osteomyelitis (OM). Methods This was a retrospective cohort study of patients enrolled in the UNC OPAT program between January 2015 and September 2018 for treatment of DFI or OM. Included patients received one of the following BL: cefepime, ceftriaxone, ertapenem, meropenem, and piperacillin/tazobactam. The primary outcome was time to first ADR during OPAT. Secondary outcomes were estimation of risk of ADR during OPAT for each medication; and ADR types and frequencies observed among patients treated with BL alone or with concomitant vancomycin or daptomycin. Results In this cohort, 178 OPAT patients received 193 OPAT courses, for a median duration of 42 days (IQR 38–50). The average patient age was 55 years, and 68% were male. Ertapenem was the most commonly prescribed BL (76 courses, 39%), followed by ceftriaxone (29, 15%), cefepime, (41, 21%), piperacillin/tazobactam (30, 16%) and meropenem (17, 9%). Approximately 40% (76) patients received concomitant vancomycin. ADR was documented in 48 patients (27%) and 56 courses of therapy (29%). Kaplan–Meier-estimated risk of at least one ADR in the first 8 weeks of therapy was 38.7% (95% CI 29.1% to 48.2%). ADR resulted in 32 therapy changes and 8 readmissions. Conclusion More than one-third of patients treated with BL for treatment of DFI and/or OM are at risk of ADR within 8 weeks. ADR commonly resulted in treatment changes, and possible hospital readmission. BL therapy is associated with significant ADR risk, and careful selection and monitoring is essential for optimal patient safety during OPAT. Disclosures All authors: No reported disclosures.
43
Mekki, Waleed Ahmed, Nikolay Mikhailovich Kliushin, and Anatoliy Sergeyevich Sudnitsyn. "Calcaneogenesis: the use of tibial bone transport for treatment of massively infected hindfoot defects." Acta Orthopaedica Belgica 88, no. 1 (March 2022): 127–34. http://dx.doi.org/10.52628/88.1.16.
Full textAbstract:
Massive hindfoot defects which result after se- questrectomy of chronic osteomyelitis (COM) or Trauma or after tumors resection is a real challenge to the treating surgeons with either amputation or other reconstructive plastic procedures as the only available options, Calcaneal osteomyelitis is a major cause with classical surgical management to cure the infection has limited success in preservation of the hindfoot shape, function, and mechanical stability. The surgical procedure reported with the use of the Ilizarov apparatus for partial or total calcaneal OM is aimed to preserve the Hindfoot. Materials and Methods We retrospectively reviewed 10 patients which were treated by radical debridement of the infected area, Ilizarov frame application and arthrodesis with bone reconstruction by the Ilizarov apparatus using tibial transport for Hindfoot salvage. The mean age at presentation was 33.5 years (range; 24-57) and the mean follow-up was 5.1 years (range; 2-12).Patients clinical and radiographic data were assessed according to the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle- Hindfoot score. Results The mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score was 48.3(range; 38-86) while the mean postoperative (AOFAS) was 58.5 (range; 45-73) , p value < 0.01 . Clinically all patients had anatomically stable feet with deformity correction and no signs of infection recurrence. Conclusion The use of Ilizarov distal tibial bone transport to fill massive hindfoot defects proved to be a reliable method for elimination of infection and reconstruction of large defects without the need for bony or soft tissue plastic procedures. The technique also has the ability to produce a rigid limb fixation following debridement and to fill in massive hindfoot defects due to other etiologies as well.
44
Duvall, Lydia, Brooks Platt, Michelle Kussin, and James B. Wood. "#73: Outcomes of Children with Osteoarticular Infections Treated with Trimethoprim–Sulfamethoxazole." Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (March 1, 2021): S7—S8. http://dx.doi.org/10.1093/jpids/piaa170.023.
Full textAbstract:
Abstract Background Early transition to oral antibiotic therapy for the treatment of children with osteoarticular infections (OAI; osteomyelitis [OM], septic arthritis [SA]) has become increasingly common, yet the choice of optimal regimen remains a challenge. With increasing resistance, poor palatability, and reported allergies to commonly used oral antibiotics, including anti-Staphylococcal penicillins and clindamycin, the treatment options for children with OAI are limited. Trimethoprim–sulfamethoxazole (TMP-SMX) is a commonly used antibiotic, with activity against frequently encountered pathogens causing OAI, yet data regarding outcomes of children with OAI treated with TMP-SMX is limited. Thus, we sought to describe the characteristics and outcomes of children with OAI, at our institution, treated with TMP-SMX. Methods Records of children aged ≤18 years old, admitted to Riley Hospital for Children between 2010 and 2018, treated with TMP-SMX for acute OAI were reviewed. Patients were identified by ICD-9/-10 codes and order for TMP-SMX. Patients were excluded if they did not receive TMP-SMX for treatment of OAI, had symptoms >30 days, or had an alternative diagnosis. Demographic, clinical, and outpatient/follow-up data were recorded. Treatment was considered successful if the patient completed treatment with TMP-SMX, and there was no evidence of infection at the end of therapy. Treatment failure was defined as the inability to tolerate the medication, development of an infection-related complication, recurrent or chronic osteomyelitis. Additionally, significant adverse drug events were recorded. Results Eighty-three subjects were identified; however, after screening, 21 subjects were deemed eligible. The majority were non-Hispanic white, males, with a median age of 1.5 years (Interquartile range [IQR], 1–3 years) (Table 1). Twelve patients (57%) had OM, seven (33%) SA, and two (10%) had both OM and SA. A pathogen was recovered in 12 patients (57%), with Staphylococcus aureus being most common. All S. aureus isolates were methicillin resistant, and three were clindamycin resistant. The median duration of intravenous antibiotics prior to discharge was 3 days (IQR 2–4 days). All patients were transitioned to a TMP-SMX containing regimen prior to discharge. The median dose of TMP-SMX was 12.7 mg/kg/day (IQR 11.3–14.9). Reasons for choosing TMP-SMX varied, with the majority (62%) being physician preference. Treatment regimens varied with the majority (62%) receiving TMP-SMX monotherapy. Two patients developed adverse drug reactions attributed to TMP-SMX. Of the 18 patients that completed follow-up, 14 (78%) successfully completed treatment with TMP-SMX. Three patients developed recurrent infections and one patient was unable to finish therapy with TMP-SMX due to developing acute kidney injury. Conclusions In our study, TMP-SMX was well tolerated; however, only 78% of patients were successfully treated. The majority of treatment failures had prolonged bacteremia due to MRSA perhaps suggesting a higher bacterial burden. The poor outcome in these patients is likely multifactorial, and antibiotic contribution is unknown. TMP-SMX may be a reasonable treatment option for children with OAI when the disease is mild; however, caution should be exercised with severe disease, especially when associated with bacteremia. Prospective, randomized control trials are needed to aid in guideline development and understand the role of TMP-SMX in the treatment of children with OAI.
45
Lowry, Michael, Christina Fiske, and Peter F. Rebeiro. "1421. Assessing Serious Infections Common in Persons Who Inject Drugs in the United States and Tennessee." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S717—S718. http://dx.doi.org/10.1093/ofid/ofaa439.1603.
Full textAbstract:
Abstract Background The opioid crisis is a public health emergency in the United States (US) and Tennessee (TN), and injection drug use predisposes users to a variety of serious infections. We therefore examined infection rates among persons who inject drugs (PWID) from 2001-2014 in the US and TN. Methods We conducted an ecological study using publicly available data including discharge diagnosis codes: the Healthcare Cost and Utilization Project (HCUP). We identified all persons from 2001-2014 with ICD-9 codes for bacterial infections common among PWID: endocarditis (IE), osteomyelitis (OM), septic arthritis (SpA), and skin/soft tissue infections (SSTI). We calculated rates of substance use and infection among all hospital discharges. Spearman’s rank correlation quantified the relationship between infection and reported hepatitis C seropositivity (HCV), Substance Abuse (SA) and opioid use disorder (OUD) rates. Poisson regression yielded incidence rate ratios (IRR) and 95% confidence intervals [-], and restricted cubic splines were fit to assess annual trends flexibly. Results Unadjusted rates of both substance use and infection among those discharged from hospitals were higher in the US overall than in TN from 2001-2014 (p< 0.05) (Figure 2,3). Overall infections, HCV (IRR=1.14 [1.12-1.17]), SSTI, OM, and SpA increased annually in the US; overall infections, HCV (IRR=1.14 [1.10-1.15]), and SSTI increased in TN. OUD (IRR=0.96 [0.94-0.98]) and IE (IRR=0.97 [0.97-0.98]) decreased in the US (Table 1). In the US, there were strong positive correlations between any other infection and HCV (ρ=0.87), IE and OUD (ρ=0.7), SSTI and HCV (ρ=0.9), OM and HCV (ρ=0.69), and SpA and HCV (ρ=0.68); IE was negatively correlated with HCV (ρ=-0.84). In TN, overall infections (ρ=0.68), and specifically SSTI (ρ=0.62), were correlated with HCV (Figure 1). Table 1 Figure 1 Figure 2 Conclusion Serious infections common in PWID are increasing in TN and the US; they correlate with HCV rates, which have risen significantly in hospitalized patients. Interestingly, opioid use disorder incidence from discharge data declined from 2001-2014 for both TN and the US, which may be due to coding lapses or shifts in type of opioid use with no well-known billing code. However, we must continue monitoring and mitigating both substance use and its sequelae. Disclosures All Authors: No reported disclosures
46
Barakat, Ahmed, Amr Ahmed, Helena White, and Jitendra Mangwani. "Reliability of Inflammatory Markers as a Diagnostic Tool for Non-Diabetic Foot and Ankle Infections: Case Series Study." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0057. http://dx.doi.org/10.1177/2473011421s00572.
Full textAbstract:
Category: Other; Ankle; Basic Sciences/Biologics; Hindfoot; Midfoot/Forefoot; Trauma Introduction/Purpose: The distinction between foot and ankle wound healing complications as opposed to infection is crucial for the appropriate and efficacious allocation of antibiotic therapy. Multiple reports have focused on the diagnostic accuracy of different inflammatory markers, however, mainly in the diabetic population. Our aim was to evaluate the diagnostic accuracy of white cell count (WCC) and C-reactive protein (CRP) as diagnostic tools for this distinction in the non-diabetic cohort. Methods: Data were reviewed from a prospectively maintained Infectious Disease Unit database of 216 patients admitted at Leicester University Hospitals - the United Kingdom with musculoskeletal infections over the period between July 2014 and February 2020 (68 months). All patients with a confirmed diagnosis of diabetes were excluded while only those with a confirmed microbiological or clinical diagnosis of foot or ankle infection were included in our study. For the included patients, we retrospectively retrieved the inflammatory markers (WCCs and CRP) at the time of presentation and during the perioperative period for debridement. Values of CRP 0-10 mg/L and WCC 4.0-11.0 x109 /L were considered normal. Results: After the exclusion of patients with confirmed diabetes, 25 patients with confirmed foot or ankle infections were included. All infections were confirmed microbiologically with positive intra-operative culture results. 7 (28%) patients with osteomyelitis (OM) of the foot, 11 (44%) with OM of the ankle, 5 (20%) with ankle septic arthritis, and 2 (8%) patients with post- surgical wound infection were identified. Previous bony surgery was identified in 52% (n=13), either a corrective osteotomy or an open reduction and internal fixation (ORIF) for a foot or ankle fracture with the infection developing on top of the existing metalwork. 84% (n=21) did have raised inflammatory markers while 16% (n=4) failed to mount an inflammatory response even with subsequent debridement and removal of metalwork. CRP sensitivity was 84%, while WCC sensitivity was only 28%. Conclusion: CRP has relatively good sensitivity in the diagnosis of foot and ankle infections in non-diabetic patients, whereas WCC is a poor inflammatory marker in the detection of such cases. In presence of a clinically high level of suspicion of foot or ankle infection, a normal CRP should not rule out the diagnosis of OM.
47
Autore, Giovanni, Luca Bernardi, and Susanna Esposito. "Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy." Antibiotics 9, no. 8 (August 6, 2020): 486. http://dx.doi.org/10.3390/antibiotics9080486.
Full textAbstract:
Acute bone and joint infections (BJIs) in children may clinically occur as osteomyelitis (OM) or septic arthritis (SA). In clinical practice, one-third of cases present a combination of both conditions. BJIs are usually caused by the haematogenous dissemination of septic emboli carried to the terminal blood vessels of bone and joints from distant infectious processes during transient bacteraemia. Early diagnosis is the cornerstone for the successful management of BJI, but it is still a challenge for paediatricians, particularly due to its nonspecific clinical presentation and to the poor specificity of the laboratory and imaging first-line tests that are available in emergency departments. Moreover, microbiological diagnosis is often difficult to achieve with common blood cultures, and further investigations require invasive procedures. The aim of this narrative review is to provide the most recent evidence-based recommendations on appropriate antinfective therapy in BJI in children. We conducted a review of recent literature by examining the MEDLINE (Medical Literature Analysis and Retrieval System Online) database using the search engines PubMed and Google Scholar. The keywords used were “osteomyelitis”, OR “bone infection”, OR “septic arthritis”, AND “p(a)ediatric” OR “children”. When BJI diagnosis is clinically suspected or radiologically confirmed, empiric antibiotic therapy should be started as soon as possible. The choice of empiric antimicrobial therapy is based on the most likely causative pathogens according to patient age, immunisation status, underlying disease, and other clinical and epidemiological considerations, including the local prevalence of virulent pathogens, antibiotic bioavailability and bone penetration. Empiric antibiotic treatment consists of a short intravenous cycle based on anti-staphylococcal penicillin or a cephalosporin in children aged over 3 months with the addition of gentamicin in infants aged under 3 months. An oral regimen may be an option depending on the bioavailability of antibiotic chosen and clinical and laboratory data. Strict clinical and laboratory follow-up should be scheduled for the following 3–5 weeks. Further studies on the optimal therapeutic approach are needed in order to understand the best first-line regimen, the utility of biomarkers for the definition of therapy duration and treatment of complications.
48
Wei, Wenjing, Norman Mang, Jessica Ortwine, Jessica A. Meisner, and Richard Lueking. "108. Evaluation of the Impact of Dalbavancin Usage on Clinical Outcomes, Cost-Savings, and Adherence at a Large Safety Net Hospital." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S168. http://dx.doi.org/10.1093/ofid/ofab466.310.
Full textAbstract:
Abstract Background Dalbavancin is a long-acting second-generation lipoglycopeptide antibiotic with potent activity against Gram-positive organisms. Dalbavancin is currently FDA approved for acute bacterial skin and soft tissue infections (ABSSTIs). Growing evidence suggests that patients can be successfully treated with dalbavancin for indications outside of skin and soft tissue infections which include bacteremia and osteomyelitis (OM) with significant cost savings and reduced length of stay. We developed a protocol for the use of dalbavancin in patients who required intravenous antibiotics for serious bacterial infections but did not qualify for outpatient parenteral antibiotic therapy (OPAT). During the COVID-19 pandemic, we expanded the protocol to reduce the amount of clinical contact required for all patients. Methods In this retrospective observational study, we reviewed all patients that received at least one dose of dalbavancin in either inpatient or outpatient setting at Parkland Hospital from July 2019 through February 2021. Patient demographics, type of infection, and rationale for dalbavancin were collected at baseline. Clinical response was measured by avoidance of Emergency Department (ED) visits or hospital readmission at 30, 60, and 90 days. In addition, a separate analysis was conducted to estimate hospital, rehabilitation, or nursing home days saved based on their diagnosis and projected length of treatment. Results Twenty-eight patients (24 inpatient, 4 outpatient) were included in the study. The majority were uninsured (89%), homeless (64%), or had active intravenous drug use (IDU) (60%). Indications for use included SSTI (42.9%), bacteremia (64.3%), and OM (42.6%). Clinical failure was observed in 4 (14%), 1 (3.5%), and 2 (7.1%) patients at 30, 60, or 90 days (respectively). Nonadherence to medical recommendations, lack of source control, and ongoing IDU increased risk of returning to the hospital. Dalbavancin use saved a total of 381 days of inpatient/rehab/facility stay. Baseline Characteristics of Patients Types of Infections and Microbiology ED Visit or Readmissions at 30, 60, or 90 Days Conclusion Dalbavancin showed similar rates of success with improved length of stay and cost savings. The use of long acting lipoglycopeptides are desirable alternatives to traditional OPAT for patients that otherwise would not qualify for OPAT or desire less hospital contact. Disclosures All Authors: No reported disclosures
49
Castillo Almeida, Natalia E., Pooja Gurram, and Omar Abu Saleh. "1384. Mycobacterium marinum Infection: 21 Years of Experience at a Tertiary-Care Hospital." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S502—S503. http://dx.doi.org/10.1093/ofid/ofz360.1248.
Full textAbstract:
Abstract Background Mycobacterium marinum is a slow-growing, non-tuberculous mycobacterium responsible for skin and soft-tissue infections (SSTIs), tenosynovitis, and osteomyelitis (OM). We conducted a retrospective study describing the risk, clinical course, and outcome of M. marinum infection. Methods Adult patients with culture-confirmed M. marinum infections were identified from the mycology laboratory at Mayo Clinic, Rochester from January 1998 to December 2018. M. marinum infection was defined as uncomplicated (limited to SST) and complicated (tenosynovitis, OM, or disseminated). Results Forty-six cases of culture-confirmed infection with M. marinum were included (Table 1). Only 16 cases (35%) reported a water exposure and 22 (48%) involved finger and/or hand trauma. The median time to diagnosis was 3.6 months. Most patients (76%) presented with uncomplicated M. marinum infection with skin lesions mainly localized in the upper limb (Table 2). QuantiFERON and PPD were positive in 4 (8%) and 2 (4%) cases, respectively. Granulomatous inflammation and positive special stains were noted in 34 (74%) and 11 (24%) cases, respectively. Cases with complicated M. marinum infection had a longer duration of symptoms and length of treatment (P < 0.05) (Table 3). Prior to diagnosis, 63% of patients received at least one antibiotic for bacterial SSTIs. More than 50% of the patients diagnosed with M. marinum received a one drug regimen and 8% did not initiate therapy. Median treatment duration was 4.4 months. Twenty-six cases (56%) had susceptibilities performed and treatment modifications were made in 10 cases (38%). From the patients that started therapy, 73% completed therapy and 33% were lost to follow up. Cured was achieved in 87% of cases that completed therapy, 2 cases (6%) had a recurrence, and only one patient with active malignancy had a positive blood culture and died. Twelve (44%) and 10 cases (37%) were cured with one and two-drug regimens, respectively. Conclusion Most patients with M. marinum infection present as an uncomplicated infection in the upper limb. Classical exposure was only suspected in a third of the cases. Patients with complicated M. marinum infection had a prolonged duration of symptoms and lengthy treatment. Most patients were successfully treated with a one and two-drug regimen. Disclosures All authors: No reported disclosures.
50
Lang, Amanda, Jacey L. Hilbers, Mason Halouska, Zachary A. Van Roy, Angela Hewlett, Angela Hewlett, Nicolas W. Cortes-Penfield, and Nicolas W. Cortes-Penfield. "254. Excellent Outcomes with Oral Versus Intravenous Antibiotics for Bone and Joint Infections: A Single-Center Experience." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S233—S234. http://dx.doi.org/10.1093/ofid/ofab466.456.
Full textAbstract:
Abstract Background The OVIVA trial, published in 2019, demonstrated equivalent efficacy of oral (PO) versus intravenous (IV) antibiotics for bone and joint infections. We report our group’s one-year outcomes in a cohort of such patients who received PO or IV antibiotics. Methods Our orthopedic surgery and orthopedic infectious diseases (ID) groups agreed to employ early switch to PO in patients with a first episode of non-vertebral osteomyelitis (OM), native or prosthetic joint infection (NJA or PJI), or hardware infections when a pathogen susceptible to highly bioavailable antibiotics had been identified and the patient was perceived to be at low risk for medication non-adherence. We reviewed patients 19+ years old seen in the Ortho ID clinic for one of these conditions from July 1st through December 31st, 2019. Data recorded included patient demographics and comorbidities, infection type and site, microbiology, and surgical and antibiotic management. Primary outcome was treatment failure at 1 year, defined as death, unplanned surgery at same site, or chronic antibiotic suppression. Results Forty patients (all IV antibiotics, n=17; initial or switch to PO, n=23) were included. Median IV duration was 15 days. PJI was the most common diagnosis (n=22), followed by other hardware infection and OM (n=7 each). Of the PJIs, 13/22 were managed with 2-stage exchange and 11/13 of these received all-IV therapy. Of the hardware infections, 4/7 underwent debridement and retention or single-stage exchange and all of these received initial or switch to PO therapy. Staphylococci (n=14 S. aureus and n=7 coagulase-negative) and streptococci (n=12) were the most common pathogens. Amoxicillin (n=8), trimethoprim-sulfa (n=6), and levofloxacin (n=3) were the most-used PO antibiotics. The PO group received longer treatment (mean 67 vs 48 days). No treatment failures occurred in the patients who started or switch to PO antibiotics, whereas 35% of patients who received all-IV therapy experienced failure. Conclusion Adopting known risk factors for poor outcome in bone and joint infection such as prior treatment failure and no identified pathogen as exclusion criteria for early switch to PO antibiotic therapy led to excellent one-year treatment outcomes across a range of musculoskeletal infections. Disclosures Angela Hewlett, MD, MS, Mapp Biopharmaceutical (Scientific Research Study Investigator) Angela Hewlett, MD, MS, Mapp Biopharmaceutical, Inc (Individual(s) Involved: Self): Scientific Research Study Investigator Nicolas W. Cortes-Penfield, MD, Nothing to disclose