Osteomyelitis: a current challenge

Jorge, Luciana Souza; Chueire, Alceu Gomes; Rossit, Andréa Regina Baptista

doi:10.1590/s1413-86702010000300020

Cited by 23 publications

(21 citation statements)

References 32 publications

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“…I -A large inoculum of bacteria reaches the medular channel; II -(Acute state) Pus resulting from inflammatory response spreads into vascular channels; III -(Chronic state) Vascular channels are compressed and obliterated by the inflammatory process, and the resulting ischaemia also contributes to bone necrosis. TABLE I -Most common isolated microorganisms in osteomyelitis are related to age and susceptibility factors (adapted from Lew, Waldvogel, 2004;Brook, 2008;McNally, Nagarajah, 2010;Chihara, Segreti, 2010;Jorge et al, 2010;Zimmerli, 2010;Eid, Berbari 2012 (Jorge et al, 2010;Eid, Berbari, 2012). There has been an increase in methicillin-resistant S. aureus (MRSA) in recent years (Chihara, Segreti, 2010), due to rapid development of antimicrobial resistance and expression of virulence factors, regardless of the patient´s immune status.…”

Section: Causal Organismsmentioning

confidence: 99%

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Osteomyelitis: an overview of antimicrobial therapy

Gomes

Pereira

Bettencourt

2013

Braz. J. Pharm. Sci.

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Osteomyelitis is an inflammatory bone disorder caused by infection, leading to necrosis and destruction of bone. It can affect all ages, involve any bone, become a chronic disease and cause persistent morbidity. Treatment of osteomyelitis is challenging particularly when complex multiresistant bacterial biofilm has already been established. Bacteria in biofilm persist in a low metabolic phase, causing persistent infection due to increased resistance to antibiotics. Staphylococcus aureus and Staphylococcus epidermidis are the most common causative organism responsible for more than 50% of osteomyelitis cases. Osteomyelitis treatment implies the administration of high doses of antibiotics (AB) by means of endovenous and oral routes and should take a period of at least 6 weeks. Local drug delivery systems, using non-biodegradable (polymethylmethacrylate) or biodegradable and osteoactive materials such as calcium orthophosphates bone cements, have been shown to be promising alternatives for the treatment of osteomyelitis. These systems allow the local delivery of AB in situ with bactericidal concentrations for long periods of time and without the toxicity associated with other means of administration. This review examines the most recent literature evidence on the causes, pathogeneses and pharmacological treatment of osteomyelitis. A osteomielite é um processo inflamatório do tecido ósseo, de origem infecciosa, que resulta em destruição inflamatória, necrose e formação de novo osso. Pode aparecer em qualquer idade, afetar qualquer osso e tornar-se uma doença crônica com morbidade persistente. Apesar dos progressos na quimioterapia infecciosa, o tratamento da osteomielite é caro e difícil, em particular quando associada à presença de biofilmes bacterianos, especialmente de Staphylococcus aureus e Staphylococcus epidermidis. O tratamento da osteomielite inclui a administração de doses elevadas de antibióticos (AB) por via endovenosa e oral, durante um período de pelo menos 6 semanas. Os sistemas de veiculação localizada de fármacos, utilizando materiais não biodegradáveis (polimetilmetacrilato) ou biodegradáveis e osteoativos como os cimentos ósseos de ortofosfatos de cálcio e vidro bioativo, surgiram como uma alternativa promissora para o tratamento da osteomielite. Estes sistemas permitem a veiculação de AB in situ com concentrações bactericidas por longos períodos de tempo e sem a toxicidade associada às outras vias de administração. O presente trabalho propõe uma revisão da literatura relativa às causas, à patogenia e ao tratamento farmacológico da osteomielite. A metodologia do estudo da revisão consistiu numa pesquisa bibliográfica, nas bases de dados Google Scholar, Science Direct, Pubmed, Springer link, B-on. Foram revistos e analisados diversos artigos publicados desde o ano de 1979.Unitermos: Osteomielite/tratamento farmacológico. Osteomielite/terapia antimicrobial. Staphylococcus aureus/presença/osteomielite. Antibióticos/uso/tratamento da osteomielite.

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Section: Causal Organismsmentioning

confidence: 99%

“…have received increasing recognition in the bacteriology of osteomyelitis, although the exact prevalence of anaerobes in this disease is unknown (Brook, 2008;Jorge et al, 2010;Furustrand et al, 2012). Anaerobes may contribute to polymicrobial osteomyelitis in vasculopathic infection such as diabetic foot infection (Eid, Berbari, 2012).…”

Section: Causal Organismsmentioning

confidence: 99%

Osteomyelitis: an overview of antimicrobial therapy

Gomes

Pereira

Bettencourt

2013

Braz. J. Pharm. Sci.

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“…Osteomyelitis is an inflammatory process of bone with resultant destructive and necrotic change accompanied by new bone formation, which can progress to a chronic or persistent stage (1). The incidence of osteomyelitis differs according to the primary inoculation and the underlying disease with a range of 1% to 15% (2,3).…”

Section: Introductionmentioning

confidence: 99%

“…Rubin evaluated 1,351,362 non-obstetric hospital discharges in New York city hospitals in 1995 and showed that an estimated 2000 (0.00147) were patients with S. aureus osteomyelitis with an average hospital stay estimated to be 23.9 days with subsequent incurred costs of 35000 dollars indicating a significant burden to the health economy (4). S. aureus is the most common pathogen responsible for both acute and chronic forms of osteomyelitis (1,5,6). S. aureus has developed a plethora of strategies to evade the host innate and adaptive immune systems, with a high resistance to different therapeutic options (7).…”

Section: Introductionmentioning

confidence: 99%

Investigating the Therapeutic Potential of a Probiotic in a Rat Model for Infection Following Fracture Fixation

et al. 2016

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“…Staphylococcus aureus is the microorganism most frequently isolated from posttraumatic and haematogenous osteomyelitis (Lew & Waldvogel 1997, Jorge et al 2010. The virulence of this bacterium is associated with its ability to penetrate the bone tissue, evade the host defences and secrete exotoxins, such as the superantigen staphylococcal enterotoxin A (SEA) (Nair et al 2000), which 57% of S. aureus strains isolated from chronic osteomyelitis patients (OST) are able to produce (Sourek et al 1979).…”

mentioning

confidence: 99%

Distinct cytokine profiles of circulating mononuclear cells stimulated with Staphylococcus aureus enterotoxin A in vitro during early and late episodes of chronic osteomyelitis

Ferreira

Moraes

Silveira

et al. 2012

Mem. Inst. Oswaldo Cruz

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We investigated the cytokine profile of peripheral mononuclear cells from chronic osteomyelitis (OST) patients following in vitro stimulation with staphylococcal enterotoxin A (SEA). We demonstrate that stimulation with SEA induced prominent lymphocyte proliferation and high levels of tumour necrosis factor (TNF)-α, interleukin (IL)-4 and IL-10 secretion in both OST and non-infected individuals (NI). Even though stimulation with SEA had no impact on IL-6 production in either patient group, the baseline level of IL-6 production by cells from OST patients was always significantly less than that produced by cells from NI. After classifying the osteomyelitic episodes based on the time after the last reactivation event as "early" (1-4 months) or "late" osteomyelitis (5-12 months), we found that increased levels of TNF-α and IL-4 in combination with decreased levels of IL-6 were observed in the early episodes. By contrast, increased levels of IL-10, IL-2 and IL-6 were hallmarks of late episodes. Our data demonstrate that early osteomyelitic episodes are accompanied by an increased frequency of "high producers" of TNF-α and IL-4, whereas late events are characterised by increased frequencies of "high producers" of IL-10, IL-6 and IL-2. These findings demonstrate the distinct cytokine profiles in chronic osteomyelitis, with a distinct regulation of IL-6production during early and late episodes.

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Osteomyelitis: a current challenge

Cited by 23 publications

References 32 publications

Osteomyelitis: an overview of antimicrobial therapy

Osteomyelitis: an overview of antimicrobial therapy

Investigating the Therapeutic Potential of a Probiotic in a Rat Model for Infection Following Fracture Fixation

Distinct cytokine profiles of circulating mononuclear cells stimulated with Staphylococcus aureus enterotoxin A in vitro during early and late episodes of chronic osteomyelitis

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