Chronic osteomyelitis increases long-term mortality risk in the elderly: a nationwide population-based cohort study

Huang, Chun‐Yen; Tsai, Kang-Ting; Weng, Shih‐Feng; Lin, Hung Jung; Huang, Hung Sheng; Wang, Jhi Joung; Guo, How‐Ran; Hsu, Chien Chin

doi:10.1186/s12877-016-0248-8

Cited by 41 publications

(33 citation statements)

References 17 publications

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“…A study about acute-care hospitalized elderly patients reported that C-reactive protein (CRP) ≥ 30 mg/l predicted mortality (OR: 3.72, 95% CI: 1.34–10.31) [ 18 ]. SA may result in subsequent osteomyelitis [ 15 ] or chronic SA, which may cause a chronic inflammation and increase long-term mortality [ 21 ]. A nationwide population-based cohort study reported that geriatric participants with chronic osteomyelitis had a significantly higher mortality risk than those without chronic osteomyelitis [incidence rate ratio (IRR): 2.29, 95% CI: 2.01–2.59] [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Septic arthritis significantly increased the long-term mortality in geriatric patients

Huang

Weng

et al. 2017

BMC Geriatr

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BackgroundThe elderly are predisposed to septic arthritis (SA) because of the aging nature and increasing comorbidities. SA may in turn increase the long-term mortality in the geriatric patients; however, it remains unclear. We conducted this prospective nationwide population-based cohort study to clarify this issue.MethodsUsing Taiwan National Health Insurance Research Database (NHIRD), we identified 1667 geriatric participants (≥ 65 years) with SA and 16,670 geriatric participants without SA matched at a ratio of 1:10 by age, sex, and index date between 1999 and 2010. A comparison of the long-term mortality between the two cohorts through follow-up until 2011 was performed.ResultsGeriatric participants with SA had a significantly increased mortality than those without SA [Adjusted hazard ratio (AHR): 1.49, 95% confidence interval (CI): 1.34–1.66], particularly the old elderly (≥ 85 years, AHR: 2.12, 95% CI: 1.58–2.84) and males (AHR: 1.54, 95% CI: 1.33–1.79). These results were stated after adjustment for osteoarthritis, diabetes, gout, renal disease, liver disease, cancer, rheumatoid arthritis, systemic lupus erythematosus, alcoholism, and human immunodeficiency virus infection. The increased mortality risk was highest in the first month (AHR: 3.93, 95% CI: 2.94–5.25) and remained increased even after following up for 2–4 years (AHR: 1.30, 95% CI: 1.03–1.65). After Cox proportional hazard regression analysis, SA (AHR: 1.37, 95% CI: 1.20–1.56), older age (≥ 85 years, AHR: 1.79, 95% CI: 1.59–2.02, 75–84 years, AHR: 1.65, 95% CI: 1.53–1.78), male sex, diabetes, renal disease, liver disease, cancer, and gout were independent mortality predictors. There was no significant difference in the mortality for SA between upper limb affected and lower limb affected.ConclusionsThis study delineated that SA significantly increased the long-term mortality in geriatric participants. For the increasing aging population worldwide, strategies for the prevention and treatment of SA and concomitant control of comorbidities are very important.

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Section: Discussionmentioning

confidence: 99%

Septic arthritis significantly increased the long-term mortality in geriatric patients

Huang

Weng

et al. 2017

BMC Geriatr

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“…In 2013, the geriatric population was 13.3% in Taiwan; however, it will rapidly grow to 20% by 2025 [2,3]. The growing geriatric population will contribute to a serious burden on the health care system because the elderly use more medical resources than their younger counterparts due to their multiple and complex comorbidities [3][4][5][6][7][8][9][10][11]. The statistics from the Taiwan National Health Insurance demonstrated that the geriatric population contributed to 38.5% of the total expenditures in 2015, and the proportion is still growing [12].…”

Section: Clinical Researchmentioning

confidence: 99%

Chronic pain and use of analgesics in the elderly: a nationwide population-based study

Huang

Tsay

Her

et al. 2020

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Introduction: Chronic pain may cause many comorbidities in the elderly; however, nationwide data about this issue remain insufficient. We conducted this study to address the data gap. Material and methods: We identified geriatric participants (≥ 65 years) with chronic pain between 2000 and 2013 from the Taiwan National Health Insurance Research Database. The causes of chronic pain and use of analgesics between two sexes and among three age subgroups were compared. Results: A total of 21,018 participants were identified with the mean age (standard deviation) of 72.7 years (5.6) and the female percentage of 50.8%. The prevalence of chronic pain in the elderly was 21.5%, and it was higher in the females than males. The proportions of each age subgroup were 65-74 (66.8%), 75-84 (29.4%), and ≥ 85 years (3.8%). Common causes of chronic pain were osteoarthritis (21.9%), spinal disorders (19.0%), peripheral vascular diseases (12.4%), and osteoporosis (11.4%). Non-steroidal anti-inflammatory drugs were the most common medication, followed by acetaminophen and opioids. The most commonly used opioid was morphine. The use of opioids increased with age. Conclusions: This study delineated the causes of chronic pain and use of analgesics in a geriatric population, which may help further studies about this issue in the future.

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“…4 The current approach to treat osteomyelitis is mainly antimicrobial and often intravenous and long-term, with surgical intervention in many cases to control infection. The causative pathogens in the majority of long bone osteomyelitis cases are biofilms of Staphylococcus aureus ; these microbes are bound to bone (Figure 1) in contrast to their planktonic (free-floating) counterparts.…”

Section: Introductionmentioning

confidence: 99%

Design, Synthesis, and Antimicrobial Evaluation of a Novel Bone-Targeting Bisphosphonate-Ciprofloxacin Conjugate for the Treatment of Osteomyelitis Biofilms

et al. 2017

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Osteomyelitis is a major problem worldwide and is devastating due to the potential for limb-threatening sequelae and mortality. Osteomyelitis pathogens are bone-attached biofilms, making antibiotic delivery challenging. Here we describe a novel osteoadsorptive bisphosphonate-ciprofloxacin conjugate (BV600022), utilizing a “target and release” chemical strategy, which demonstrated a significantly enhanced therapeutic index versus ciprofloxacin for the treatment of osteomyelitis in vivo. In vitro antimicrobial susceptibility testing of the conjugate against common osteomyelitis pathogens revealed an effective bactericidal profile and sustained release of the parent antibiotic over time. Efficacy and safety were demonstrated in an animal model of periprosthetic osteomyelitis, where a single dose of 10 mg/kg (15.6 µmol/kg) conjugate reduced the bacterial load by 99% and demonstrated nearly an order of magnitude greater activity than the parent antibiotic ciprofloxacin (30 mg/kg, 90.6 µmol/kg) given in multiple doses. Conjugates incorporating a bisphosphonate and an antibiotic for bone-targeted delivery to treat osteomyelitis biofilm pathogens constitute a promising approach to providing high bone-antimicrobial potency while minimizing systemic exposure.

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Chronic osteomyelitis increases long-term mortality risk in the elderly: a nationwide population-based cohort study

Cited by 41 publications

References 17 publications

Septic arthritis significantly increased the long-term mortality in geriatric patients

Septic arthritis significantly increased the long-term mortality in geriatric patients

Chronic pain and use of analgesics in the elderly: a nationwide population-based study

Design, Synthesis, and Antimicrobial Evaluation of a Novel Bone-Targeting Bisphosphonate-Ciprofloxacin Conjugate for the Treatment of Osteomyelitis Biofilms

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