Hyperbaric Oxygen as Adjunctive Therapy for Osteomyelitis

Mader, Jon T.; Adams, Kenneth R.; Wallace, William R.; Calhoun, Jason H.

doi:10.1016/s0891-5520(20)30355-x

Cited by 51 publications

(6 citation statements)

References 11 publications

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“…The applied treatment schedule with 90 min of HBOT adheres to recommended protocols (duration b120 min, pressure b 3 ATA and b 40 sessions) [22]. HBOT has clinically been used to treat bacterial infections such as chronic and refractory osteomyelitis [52], bacterial brain abscesses [53], necrotizing fasciitis [53,54,55], and chronic non-healing wounds [56]. HBOT has also been shown to enhance the leukocytemediated killing of aerobic organisms [52].…”

Section: Discussionmentioning

confidence: 99%

“…HBOT has clinically been used to treat bacterial infections such as chronic and refractory osteomyelitis [52], bacterial brain abscesses [53], necrotizing fasciitis [53,54,55], and chronic non-healing wounds [56]. HBOT has also been shown to enhance the leukocytemediated killing of aerobic organisms [52]. However, before planning treatment of CF patients with bacterial lung infections, a separate risk assessment is needed although serious adverse effects are rare when HBOT is used appropriately [22].…”

Section: Discussionmentioning

confidence: 99%

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Hyperbaric oxygen treatment increases killing of aggregating Pseudomonas aeruginosa isolates from cystic fibrosis patients

Møller

Jensen

Høiby

et al. 2019

Journal of Cystic Fibrosis

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Background: Pseudomonas aeruginosa is a major pathogen of the chronic lung infections in cystic fibrosis (CF) patients. These persistent bacterial infections are characterized by bacterial aggregates with biofilm-like properties and are treated with nebulized or intravenous tobramycin in combination with other antibiotics. However, the chronic infections are close to impossible to eradicate due to reasons that are far from fully understood. Recent work has shown that re-oxygenation of hypoxic aggregates by hyperbaric oxygen (O 2 ) treatment (HBOT: 100% O 2 at 2.8 bar) will increase killing of aggregating bacteria by antibiotics. This is relevant for treatment of infected CF patients where bacterial aggregates are found in the endobronchial secretions that are depleted of O 2 by the metabolism of polymorphonuclear leukocytes (PMNs). The main objective of this study was to investigate the effect of HBOT as an adjuvant to tobramycin treatment of aggregates formed by P. aeruginosa isolates from CF patients. Methods: The effect was tested using a model with bacterial aggregates embedded in agarose. O 2 profiling was used to confirm re-oxygenation of aggregates. Results: We found that HBOT was able to significantly enhance the effect of tobramycin against aggregates of all the P. aeruginosa isolates in vitro. The effect was attributed to increased O 2 levels leading to increased growth and thus increased uptake of and killing by tobramycin. Conclusions: Re-oxygenation may in the future be a clinical possibility as adjuvant to enhance killing by antibiotics in cystic fibrosis lung infections.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hyperbaric oxygen treatment increases killing of aggregating Pseudomonas aeruginosa isolates from cystic fibrosis patients

Møller

Jensen

Høiby

et al. 2019

Journal of Cystic Fibrosis

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“…Hypoxia is a hallmark of infectious diseases, and HBOT is approved and indicated in severe bacterial infections such as necrotizing soft tissue infection (Wilkinson and Doolette, 2004), chronic wounds (Sanford et al, 2018), refractory osteomyelitis (Mader et al, 1978(Mader et al, , 1990, and intracranial abscesses (Bilic et al, 2012). Although HBOT is a well-established treatment used both for infectious and non-infectious diseases, there is a need for improved clinical documentation.…”

Section: Clinical Application Of Hyperbaric Oxygen Therapy In Infective Endocarditismentioning

confidence: 99%

Anti-biofilm Approach in Infective Endocarditis Exposes New Treatment Strategies for Improved Outcome

Lerche

Schwartz

Theut

et al. 2021

Front. Cell Dev. Biol.

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Infective endocarditis (IE) is a life-threatening infective disease with increasing incidence worldwide. From early on, in the antibiotic era, it was recognized that high-dose and long-term antibiotic therapy was correlated to improved outcome. In addition, for several of the common microbial IE etiologies, the use of combination antibiotic therapy further improves outcome. IE vegetations on affected heart valves from patients and experimental animal models resemble biofilm infections. Besides the recalcitrant nature of IE, the microorganisms often present in an aggregated form, and gradients of bacterial activity in the vegetations can be observed. Even after appropriate antibiotic therapy, such microbial formations can often be identified in surgically removed, infected heart valves. Therefore, persistent or recurrent cases of IE, after apparent initial infection control, can be related to biofilm formation in the heart valve vegetations. On this background, the present review will describe potentially novel non-antibiotic, antimicrobial approaches in IE, with special focus on anti-thrombotic strategies and hyperbaric oxygen therapy targeting the biofilm formation of the infected heart valves caused by Staphylococcus aureus. The format is translational from preclinical models to actual clinical treatment strategies.

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“…Refractory osteomyelitis is defined as a chronic osteomyelitis that persists or recurs either after definitive surgical debridement or after a period of 4 to 6 weeks of appropriate antibiotic therapy. 1,17 The Cierny-Mader classification of osteomyelitis can be used as a guide to determine which patients will most likely benefit from adjunctive HBOT. Stage 1 disease in the Cierny-Mader classification is primarily managed with antibiotics alone.…”

Section: Refractory Osteomyelitismentioning

confidence: 99%

“…If osteomyelitis fails to resolve or recurs after a total of 6 to 8 weeks of continuous, culture-directed antibiotics and hyperbaric oxygen treatment (30-40 sessions), then nidus for reinfection, such as occult sequestra or fixation hardware refractory to sterilization, should be suspected. 1,17 Delayed Radiation Injuries (Soft Tissue and Bony Necrosis) Delayed radiation injuries are typically seen after a latent period of 6 months or more and may develop many years after the radiation exposure. Sometimes, delayed injuries are precipitated by an additional tissue insult such as surgery within the radiation field.…”

Section: Refractory Osteomyelitismentioning

confidence: 99%

Anesthesia for bedside surgical procedures

2016

Trauma, Critical Care and Surgical Emergencies

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Hyperbaric oxygen is a treatment in which a patient breathes 100% oxygen intermittently while inside a treatment chamber at a pressure higher than at sea level pressure (ie, .1 atm). In certain circumstances, it represents the primary treatment modality, whereas in others it is an adjunct to surgical or pharmacologic interventions. After reviewing all the scientific evidence available to date, the Undersea and Hyperbaric Medical Society, in its latest publication, Hyperbaric Oxygen Therapy Indications (12th ed.), recommends 13 indications for hyperbaric oxygen therapy. Several of these indications are related to our practice of wound care. The article discusses these indications in detail.

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Hyperbaric Oxygen as Adjunctive Therapy for Osteomyelitis

Cited by 51 publications

References 11 publications

Hyperbaric oxygen treatment increases killing of aggregating Pseudomonas aeruginosa isolates from cystic fibrosis patients

Hyperbaric oxygen treatment increases killing of aggregating Pseudomonas aeruginosa isolates from cystic fibrosis patients

Anti-biofilm Approach in Infective Endocarditis Exposes New Treatment Strategies for Improved Outcome

Anesthesia for bedside surgical procedures

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