Pressure Ulcer-Related Pelvic Osteomyelitis: A Neglected Disease?

Abstract

Pressure-ulcer related pelvic osteomyelitis is a neglected disease of the developed world. Diagnostic strategies vary and dual infections (e.g., urinary tract infection) are common. A combined medical-surgical approach to treatment is associated with fewer readmissions compared to antibiotic therapy alone.

Orthopaedic biofilm infections

“…In a study on 67 patients with posttraumatic and postoperative (exogenous) osteomyelitis, 33% were caused by coagulase-negative staphylococci, 30% Table 1. Different pathogenetic types of chronic osteomyelitis Persistent chronic osteomyelitis after exclusive surgical therapy during the preantibiotic era (9,10) Chronic haematogenous osteomyelitis in children (6,11,12) Progression to chronic osteomyelitis because of insufficient diagnostic work-up in patients treated for deep soft-tissue infection (18,19) Diabetic foot osteomyelitis (14) Osteomyelitis in patients with sacral pressure ulcer (13,15) Sternal wound osteomyelitis after sternotomy (16) Persistent chronic osteomyelitis in patients with insufficiently treated infection associated with an internal fracture fixation device (17) by S. aureus, 21% by Gram-negative bacilli and 19% by Enterococcus spp. In 9% of the cases, no microorganism could be detected (25).…”

“…In addition, an appropriate combined surgical and antibiotic management of implant-associated infection ameliorated during the last decades (7,8). The most frequent types of chronic osteomyelitis are summarized in Table 1 (6,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). There are several publications, reporting late recurrence of chronic osteomyelitis in patients who suffered from acute osteomyelitis in the preantibiotic era or in their childhood.…”

Review of the Current Management of Pressure Ulcers

“…Because the area of skin breakdown is smaller than the total area affected, CT or MRI can be useful in defining the extent of the tissue involved and to determine whether osteomyelitis is present. 33 Wound cultures are not routinely performed, but should be considered with lack of ulcer healing and persistent evidence of infection. If a wound culture is to be performed, tissue culture is more informative than simply performing a swab of the wound.…”

A retrospective study: Multivariate logistic regression analysis of the outcomes after pressure sores reconstruction with fasciocutaneous, myocutaneous, and perforator flaps

“…Fourth, we did not include the factor of pressure sore-related pelvic osteomyelitis in this study. (14). We should take into account of this factor before reconstruction.…”