Osteomyelitis: a current challenge

Abstract

Over the last 30 years, the pathogenesis of osteomyelitis has almost been totally elucidated, and many factors responsible for the persistence of this infection have been identified. Numerous antimicrobial agents with distinct spectrums of action, pharmacokinetics, and pharmacodynamics have been used in its treatment. Surgical techniques, including muscle grafts, the Ilizarov technique, and antibiotic bone cements, have been applied. However, bone infections are still a challenge. Despite the importance of isolation and identification of microorganisms to determine the antimicrobial treatment of bone infections, there are few systematic national studies about the etiological profile of these diseases. This article describes the current knowledge of osteomyelitis and summarizes published national data based on the experience of different Orthopedic and Traumatology Services. In general, S. aureus was described as an important etiological agent; however, the difference in design of national studies makes a comparison between the prevalence of bone infection, the associated risk factors, and the different therapeutic approaches difficult. In conclusion, effort is necessary in order to stimulate systematic national studies in different Orthopedics and Traumatology Services to obtain a better consensus on preventive measures and therapies of bone infections.

Atypical presentation of thoracic spondylodiscitis caused byStreptococcus mitis

“…In most patients with spondylodiscitis, appropriate antimicrobial therapy leads to a complete recovery and good prognosis 1 3 7. Surgery is needed in a minority of patients 1 7.…”

“…Surgery is needed in a minority of patients 1 7. Ideally, antimicrobial therapy should be guided by results of susceptibility testing of isolated pathogen.…”

“…The incidence of spondylodiscitis in developed countries was reported to range from 4 to 24 per million per year, depending on the location, era and inclusion criteria of the studies 1. Owing to its rarity in adult population and vague presentation, the diagnosis of spondylodiscitis is frequently delayed 1–3.…”

“…Owing to its rarity in adult population and vague presentation, the diagnosis of spondylodiscitis is frequently delayed 1–3. The most common organism that causes spondylodiscitis in adults is Staphylococcus aureus , which accounts for more than 50% of cases in developed countries 1 2. As a Gram-positive bacteria that frequently resides in the respiratory tract and on the skin, S. aureus generally reaches the spine via three routes, including haematogenous spread, direct inoculation from trauma or spinal surgery and contiguous spread from adjacent infected tissues.…”

Chronic osteomyelitis: what the surgeon needs to know

“…2,3 The infection can be limited to the bone, or it can propagate to the bone marrow, the periosteum and the surrounding soft tissues. 2,4 It represents a major financial burden for every health system and substantially affects the quality of life of the affected patients and their families.…”