Outcomes and Risk Factors for Polymicrobial Posttraumatic Osteomyelitis

Abstract

Background: We hypothesized that polymicrobial posttraumatic osteomyelitis (PTO) may be associated with worse outcomes when compared to monomicrobial PTO. We therefore attempted to show the outcomes and predisposing factors associated with polymicrobial PTO.Methods: A single-center case-control study was carried out from 2007 to 2012. The outcome variables analyzed were: the need for additional surgical and antibiotic treatments, rates of amputation, and mortality associated with the infection. Univariate and multivariable analyses using multiple logistic regression were performed to identify risk factors associated with polymicrobial PTO, and p < 0.05 was considered significant.Results: Among the 193 patients identified, polymicrobial PTO was diagnosed in 37.8%, and was significantly associated with supplementary surgical debridement (56.1% vs. 31%; p < 0.01), a higher consumption of antibiotics, and more amputations (6.5% vs 1.3%; p < 0.01). Factors associated with polymicrobial PTO in the multivariable analysis were older age (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 1.01 to 1.03, p = 0.04), working in agriculture (OR = 2.86, 95% CI = 1.05 to 7.79, p = 0.04), open fracture Gustilo type III (OR = 2.38, 95% CI = 1.02 to 5.56, p = 0.04), need for blood transfusion (OR = 2.15, 95% CI = 1.07 to 4.32, p = 0.03), and need for supplementary debridement (OR = 2.58, 95% CI = 1.29 to 5.16, p = 0.01).Conclusions: PTO is polymicrobial in more than one-third of patients, associated with extra surgical and clinical treatment, and worse outcomes including higher rates of amputation.

Polymicrobial infections and microbial patterns in infected nonunions – a descriptive analysis of 42 cases

“…Thus, infected nonunions can be compared to posttraumatic osteomyelitis being a chronic bone infection as well. Jorge et al reported 37.8% polymicrobial infections using standard culturing techniques in posttraumatic osteomyelitis [12]. Wimmer and co-workers reported 46.6% polymicrobial infections in PJI [8], while Bozhkova et al found 28.5% PJIs to be polymicrobial [13].…”

“It Takes a Village”: Mechanisms Underlying Antimicrobial Recalcitrance of Polymicrobial Biofilms

“…Multispecies biofilm-like communities are responsible for causing persistent infections in a wide range of body sites, including the lung (24)(25)(26)(27)(28)(29)(30)(31), oral cavity (32,33), middle ear (34)(35)(36), urinary tract (37)(38)(39), and both surgical and chronic wounds (40)(41)(42)(43)(44)(45). In several disease settings, polymicrobial infections have been reported to cause worse outcomes than single-species infections (46)(47)(48)(49)(50)(51)(52)(53)(54). In particular, polymicrobial bloodstream infections are associated with higher rates of mortality than monospecies infections (46)(47)(48)(49)(50).…”

Quorum Sensing and Toxin Production in Staphylococcus aureus Osteomyelitis: Pathogenesis and Paradox

“…In fact, commensal species with distinct agr types have the ability to attenuate virulence in pathogenic species when co-colonizing mucosal surfaces, thereby protecting the host from S. aureus virulence factors regulated by Agr [103,104]. Polymicrobial S. aureus infections are frequently characterized in post-traumatic osteomyelitis and are associated with more severe patient outcomes [105]. In other disease models, co-infecting bacterial species, including Pseudomonas aeruginosa, augment S. aureus agr expression [106].…”