Intraoperative Site Vancomycin Powder Application in Infected Diabetic Heel Ulcers With Calcaneal Osteomyelitis

Brodell, James D.; Kozakiewicz, Lauren N.; Hoffman, Samantha; Oh, Irvin

doi:10.1177/1071100720962480

Cited by 11 publications

(14 citation statements)

References 22 publications

(45 reference statements)

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“…The use of topical antibiotic therapy is controversial in the setting of osteomyelitis treatment. Traditionally, antibiotic-eluting beads have been used as a local antibiotic delivery source with variable effects on treatment outcomes depending on the anatomical location examined [168][169][170] . The twostage exchange for PJI, with a first-stage placement of an antibiotic eluting spacer, is considered the standard of care for chronic PJI; however, the necessity of the antibiotic elution from the spacer versus limb support and treatment of dead space (empty space from excised tissue) remains controversial.…”

Section: Synovial Fluidmentioning

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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Section: Synovial Fluidmentioning

confidence: 99%

Skeletal infections: microbial pathogenesis, immunity and clinical management

et al. 2022

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“…Infection will lead to painful wound, a sign which should be carefully evaluated especially in diabetic patients. In our study 71.67% had pain on wounds while 28.33% did not had painful wound [19][20][21] . Swelling around the wound is expected initially but if it is associated with un-usual pain or fail to subside over certain time period, infection must be ruled out 22,23 .…”

Section: Discussionmentioning

confidence: 43%

“…Glucosuria is high level of sugar in urine which can lead to renal function compromise because kidneys have to filter out high glucose levels. DM also alter the carbohydrate metabolism in the body which leads to these systemic complications 21,26 . Diabetic ketoacidosis is a dangerous escalation of uncontrolled blood sugar levels.…”

Section: Discussionmentioning

confidence: 99%

Wound Healing in Diabetic Patients

Bilal¹,

Hanan²,

Bashir³

et al. 2022

PJMHS

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Introduction: Diabetes mellitus (DM) is a very common disease that results from the body’s inability to maintain blood glucose level within normal limits. Blood glucose levels are either too high or too low. One study shows that up-to 30% people with DM experience skin problems. If blood sugar levels are well controlled, the rate of wound healing and developing a severe infection is significantly less. Regarding management of wound in diabetic patients, keep wounds dry with meticulous dressing, limb elevation, protect the surgical fixation in splint or braces for an extended period of time and patient education to keep in touch wither consultant and promptly report any unusual discomfort, pain, wound discharge, soaking of dressing and systemic symptoms. Objectives: the objective of this study is to identify the risk of wound infection and rate of healing in diabetic patient. Materials and Methods: The study was conducted at orthopedic department of Gulab Devi hospital. It was a Cross sectional study. The data was collected from September 2021 to February 2022. Non–Probability purposive sampling technique was used. The data was collected from indoor of Gulab Devi Chest Hospital Lahore and informed consent was taken from all the patients. The target populations were those who have diabetes mellitus and treated in orthopedic ward at Gulab Devi hospital Lahore. Diabetic patients enrolled in the presented study n=60. Results: our patient population was 28 to 55 year old with mean age 40years. 83% were in 35 to 40 age group. Wound problems were frequently encountered in patients with uncontrolled diabetes and 50% (n=30) of these patients had at least one wound complication after operation. And 71% (n=43) patients had increased pain and delayed recovery of their surgical wounds. When it comes to the relationship between bone health and diabetes, 63% (n=38) patients had history of previous bone fracture and 61% (n=37) patients had deformity of bone. Due to diabetic neuropathy 68% (n=41) patient were weight bearing on fracture site without concern. And the risk of diabetes include slow wound healing 75%. Practical implication; we aim to raise awareness among treating surgeons and physicians of patients presenting with diabetes and planning to undergo surgical intervention. Meticulous wound care and strict control of blood sugar levels are paramount to successful outcome. Conclusion: Diabetes mellitus is a systemic disease associated with uncontrolled blood sugar levels with systemic manifestations. Our study has proved an association of high wound complication with DM patients. Strict diabetic control as well as extra vigilance and meticulous techniques are needed to prevent complications in this group of patients. Keywords: Diabetes mellitus, infected wound, diabetes complications, wound healing

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“…In recent years, the local use of antibiotics has been widely used in practice. Multiple clinical studies have reported a good effect of VCSI in the treatment of chronic osteomyelitis [ 9 , 10 ]. The primary objective of this retrospective study was to compare the efficiency of FD and VCSI in the treatment of sclerosing osteomyelitis.…”

Section: Introductionmentioning

confidence: 99%

A comparison of the vancomycin calcium sulfate implantation versus fenestration decompression for the treatment of sclerosing osteomyelitis

Hua

Wang

Guo

et al. 2021

BMC Musculoskelet Disord

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Objective To compare the clinical efficacy of vancomycin calcium sulfate implantation and fenestration decompression in the treatment of sclerosing osteomyelitis. Method A retrospective analysis for 46 cases of sclerosing osteomyelitis were admitted to our department between June 2010 to June 2020. Twenty-one patients were treated with fenestration decompression, twenty-five patients were treated with vancomycin calcium sulfate implantation. The postoperative hospital stay, days of drainage tube placement, visual analogue scale scores, C-reactive protein and erythrocyte sedimentation rate were compared between the two groups. Results The visual analogue scale scores of both groups were significantly lower than before treatment (p < 0.05), but the difference between them was not statistically significant. Patients treated by vancomycin calcium sulfate implantation had shorter postoperative hospital stay and days of drainage tube placement compared to those treated by fenestration decompression (p < 0.05). C-reactive protein and erythrocyte sedimentation rate in both groups were significantly lower than before treatment, but the improvement effect of vancomycin calcium sulfate implantation was better (p < 0.05). Conclusion Both treatment methods can relieve pain effectively. Compared with fenestration decompression, vancomycin calcium sulfate implantation can shorten the treatment time effectively, control the infection better.

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Intraoperative Site Vancomycin Powder Application in Infected Diabetic Heel Ulcers With Calcaneal Osteomyelitis

Cited by 11 publications

References 22 publications

Skeletal infections: microbial pathogenesis, immunity and clinical management

Skeletal infections: microbial pathogenesis, immunity and clinical management

Wound Healing in Diabetic Patients

A comparison of the vancomycin calcium sulfate implantation versus fenestration decompression for the treatment of sclerosing osteomyelitis

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