Osteomyelitis: an overview of antimicrobial therapy

Abstract

Osteomyelitis is an inflammatory bone disorder caused by infection, leading to necrosis and destruction of bone. It can affect all ages, involve any bone, become a chronic disease and cause persistent morbidity. Treatment of osteomyelitis is challenging particularly when complex multiresistant bacterial biofilm has already been established. Bacteria in biofilm persist in a low metabolic phase, causing persistent infection due to increased resistance to antibiotics. Staphylococcus aureus and Staphylococcus epidermidis are the most common causative organism responsible for more than 50% of osteomyelitis cases. Osteomyelitis treatment implies the administration of high doses of antibiotics (AB) by means of endovenous and oral routes and should take a period of at least 6 weeks. Local drug delivery systems, using non-biodegradable (polymethylmethacrylate) or biodegradable and osteoactive materials such as calcium orthophosphates bone cements, have been shown to be promising alternatives for the treatment of osteomyelitis. These systems allow the local delivery of AB in situ with bactericidal concentrations for long periods of time and without the toxicity associated with other means of administration. This review examines the most recent literature evidence on the causes, pathogeneses and pharmacological treatment of osteomyelitis. A osteomielite é um processo inflamatório do tecido ósseo, de origem infecciosa, que resulta em destruição inflamatória, necrose e formação de novo osso. Pode aparecer em qualquer idade, afetar qualquer osso e tornar-se uma doença crônica com morbidade persistente. Apesar dos progressos na quimioterapia infecciosa, o tratamento da osteomielite é caro e difícil, em particular quando associada à presença de biofilmes bacterianos, especialmente de Staphylococcus aureus e Staphylococcus epidermidis. O tratamento da osteomielite inclui a administração de doses elevadas de antibióticos (AB) por via endovenosa e oral, durante um período de pelo menos 6 semanas. Os sistemas de veiculação localizada de fármacos, utilizando materiais não biodegradáveis (polimetilmetacrilato) ou biodegradáveis e osteoativos como os cimentos ósseos de ortofosfatos de cálcio e vidro bioativo, surgiram como uma alternativa promissora para o tratamento da osteomielite. Estes sistemas permitem a veiculação de AB in situ com concentrações bactericidas por longos períodos de tempo e sem a toxicidade associada às outras vias de administração. O presente trabalho propõe uma revisão da literatura relativa às causas, à patogenia e ao tratamento farmacológico da osteomielite. A metodologia do estudo da revisão consistiu numa pesquisa bibliográfica, nas bases de dados Google Scholar, Science Direct, Pubmed, Springer link, B-on. Foram revistos e analisados diversos artigos publicados desde o ano de 1979.Unitermos: Osteomielite/tratamento farmacológico. Osteomielite/terapia antimicrobial. Staphylococcus aureus/presença/osteomielite. Antibióticos/uso/tratamento da osteomielite.

Bacteriological Profile of Osteomyelitis Cases With Special Reference to Antibiotic Susceptibility Pattern of Isolates in a Tertiary Care Hospital of Eastern India

“…1 Thus, earlier diagnosis like x-ray and bacterial cultures are needed to prevent unnecessary morbidity and mortality. The other main issue that needs to be addressed during treatment is proper care of wound, debridement of dead tissue, earlier treatment with combination with parenteral and oral antibiotics that will help in reducing the development of resistance among organisms.…”

“…Due to increase in road traffic accidents resulting in compound fractures and also increase in the number of orthopaedic surgeons using implants, iatrogenic and chronic osteomyelitis is being encountered more frequently. 1 Also, due to poverty and illiteracy prevailing in this region, there are more chances of acute osteomyelitis turning into chronic cases and presenting in the hospital. The study was therefore undertaken to determine the bacteriological profile of these cases of osteomyelitis and also to ascertain the antibiotic susceptibility pattern of these isolates that will go a long way in helping the clinician in deciding upon the treatment regime for these patients.…”

Chronic suppurative osteomyelitis: A case report

“…"Osteomyelitis" is derived from the prehistoric Greek words osteon meaning bone and muelinos meaning marrow. [1] Osteomyelitis of jaws is a common disease but dreadful due to its need for prolonged therapy, which sometimes results in disfigurement and dysfunction of the affected area. [2] In the recent past, the occurrence of osteomyelitis of the jaws has declined because of the availability of newer antimicrobial agents and also improved dental care.…”

Antibiotic and chemotherapeutic enhanced three-dimensional printer filaments and constructs for biomedical applications

“…Osteomyelitis is difficult to treat, and for the patient who is unresponsive to antibiotic therapy, it can lead to amputation or even death. 15 Chronic osteomyelitis often requires surgical debridement or local antibiotic treatment. 15,16 Implanted antibiotic-impregnated beads have numerous advantages over systemic therapy.…”

“…15 Chronic osteomyelitis often requires surgical debridement or local antibiotic treatment. 15,16 Implanted antibiotic-impregnated beads have numerous advantages over systemic therapy. These include ease of placement, decreased systemic toxicity, reduced hospital stay, and less patient cost.…”