Epidemiology, Microbiology and Therapeutic Consequences of Chronic Osteomyelitis in Northern China: A Retrospective Analysis of 255 Patients

Ma, Xianzhi; Han, Shengshou; Ma, Jun; Chen, Xiaotao; Bai, Wenbin; Yan, Wenqi; Wang, Kai

doi:10.1101/316836

Cited by 3 publications

(4 citation statements)

References 30 publications

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“…In musculoskeletal trauma patients, these diagnostic tests should be interpreted with caution [7]. A secondary rise after initial decrease or an otherwise unexplained consistent elevation over a Table 1 Most common microorganisms in fracture-related infection [11,12]…”

Section: Serum Inflammatory Markersmentioning

confidence: 99%

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Pathogenesis and management of fracture-related infection

Depypere

Morgenstern

Kuehl

et al. 2020

Clinical Microbiology and Infection

149

107

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Background: Both fracture-related infections (FRIs) and periprosthetic joint infections (PJIs) include orthopaedic implant-associated infections. However, key aspects of management differ due to the bone and soft tissue damage in FRIs and the option of removing the implant after fracture healing. In contrast to PJIs, research and guidelines for diagnosis and treatment in FRIs are scarce. Objectives: This narrative review aims to update clinical microbiologists, infectious disease specialists and surgeons on the management of FRIs. Sources: A computerized search of PubMed was performed to identify relevant studies. Search terms included 'Fracture' and 'Infection'. The reference lists of all retrieved articles were checked for additional relevant references. In addition, when scientific evidence was lacking, recommendations are based on expert opinion. Content: Pathogenesis, prevention, diagnosis and treatment of FRIs are presented. Whenever available, specific data of patients with FRI are discussed. Implications: Management of patients with FRI should take into account FRI-specific features. Treatment pathways should implement a multidisciplinary approach to achieve a good outcome. Recently, international consensus guidelines were developed to improve the quality of care for patients suffering from this severe complication, which are highlighted in this review.

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Section: Serum Inflammatory Markersmentioning

confidence: 99%

“…Moreover, tissue specimens show the greatest accuracy when inoculated in blood culture bottles [47,48]. Bacterial culture of sinus tracts is not recommended as contamination with commensal skin flora is common [12,32].…”

Section: Microbiologymentioning

confidence: 99%

Pathogenesis and management of fracture-related infection

Depypere

Morgenstern

Kuehl

et al. 2020

Clinical Microbiology and Infection

149

107

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“…Upper extremity 189,190 Vertebral [191][192][193] Lower extremity prosthetic joint [194][195][196] Trauma or fracture related 8,197,198 Haematogenous 199 Foot and ankle of infections by restricting blood flow to the area 39 . Although these bacterial lesions, also described as Brodie abscesses when found in bone tissue, have been studied for two centuries 40 , recent research has formally demonstrated their resistance to standard-of-care antibiotics and host immune responses 41,42 .…”

Section: Speciesmentioning

confidence: 99%

Skeletal infections: microbial pathogenesis, immunity and clinical management

et al. 2022

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Osteomyelitis is an infection of bone that can result from contiguous spread from surrounding tissue, direct bone trauma due to surgery or injury, or haematogenous spread from systemic bacteraemia. It remains a significant health-care burden with a prevalence of ~22 cases per 100,000 person-years in the United States, and its incidence has been rising over time, especially in the elderly and individuals with diabetes 1 . Although it is a heterogeneous disease, subset classifications include implant-associated osteomyelitis (including peri-prosthetic joint infection (PJI) and instrumented spinal infections), fracture-related infection, acute haematogenous osteomyelitis, diabetic foot infection, septic arthritis and native spinal osteomyelitis.Crucial to expanding our understanding of osteomyelitis and advancing treatment algorithms has been the application of animal models, which illustrate the interaction between the pathogen and cells of both the immune and skeletal systems in a manner that in vitro models cannot yet replicate. Animal models are available to study virtually all aspects of skeletal infection, and typically involve inoculation of bacteria at the time of implant placement (Fig. 1). They can vary in complexity from simple models where metal implants are placed under the skin (for example, tissue cage 2 ) or into cortical bone (for example, metal wire 3 ) versus more complex models that mimic functional orthopaedic devices 4 . Additionally, approaches have been developed to induce non-implant infections by haematogenous inoculation into the tail vein 5 , direct inoculation into vertebral bodies or intervertebral discs 6 to induce vertebral osteomyelitis, or inoculation into the foot pad of diabetic obese rodents to induce diabetic foot infection 7 .As disease pathogenesis differs across different infection classes, so does microbial aetiology. Many different microorganisms have been implicated in skeletal infection, and the most common, along with their incidence and tropism, are shown in Table 1. In general, Staphylococcus aureus and coagulase-negative staphylococci (CoNS), such as Staphylococcus epidermidis and Staphylococcus lugdunensis, are responsible for up to two-thirds of all skeletal infections, with S. aureus being the most prevalent single pathogen. Additionally, antimicrobial resistance remains a challenge in osteomyelitis treatment with up to 50% of cases of S. aureus osteomyelitis caused by methicillin-resistant S. aureus (MRSA) strains 8 . Other less commonly identified pathogens include Enterococcus spp., Pseudomonas aeruginosa, Escherichia coli and Cutibacterium acnes (Table 1). Most cases of osteomyelitis are monomicrobial; however,

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“…1,2 Chronic osteomyelitis is more common in men and the most common sites of infection are the femur, tibiofibular and hip joints. 2 Research at Hasan Sadikin Hospital showed that most osteomyelitis patients had experienced chronic onset (94.4%). 3 Antimicrobial therapy and surgical debridement are the main modalities for managing chronic osteomyelitis.…”

Section: Introductionmentioning

confidence: 99%

Chronic osteomyelitis treatment with PerOssal®: a literature review

Mardana¹,

Kesuma²,

Saputra³

et al. 2022

Intisari Sains Medis

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Chronic osteomyelitis is an inflammatory process in the bone followed by bone destruction caused by microorganism infection. The annual incidence of osteomyelitis is approximately 21.8 cases per 100,000 person-years in the general population. Implanting antibiotic-loaded carriers directly at the site of infection becomes a promising treatment approach. PerOssal® is an osteoconductive synthetic bone substitute for restoring and filling bone defects. PerOssal® pellets contain 51.1% nanocrystalline hydroxyapatite and 48.5% calcium sulfate. It has a role as bone material to fill bone defects caused by dead bone in chronic osteomyelitis. The porosity of PerOssal® allows a high initial antibiotic release, then decreases to ensure a local concentration of the antibiotic. PerOssal® did not show any in vitro cytotoxicity and fatal adverse event as bone material. PerOssal® is a promising antibiotic-loaded carrier for the management of chronic osteomyelitis. It demonstrates good biocompatibility with initial high antibiotic release without in vitro cytotoxicity and fatal adverse event.

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Epidemiology, Microbiology and Therapeutic Consequences of Chronic Osteomyelitis in Northern China: A Retrospective Analysis of 255 Patients

Cited by 3 publications

References 30 publications

Pathogenesis and management of fracture-related infection

Pathogenesis and management of fracture-related infection

Skeletal infections: microbial pathogenesis, immunity and clinical management

Chronic osteomyelitis treatment with PerOssal®: a literature review

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