The Effectiveness of Local Antibiotics in Treating Chronic Osteomyelitis in a Cohort of 50 Patients with an Average of 4 Years Follow-Up

Abstract

The treatment of chronic osteomyelitis requires both appropriate surgical and antibiotic management. Prolonged intravenous antibiotic therapy followed by oral therapy is widely utilised. Despite this, the long-term recurrence rate can be up to 30%.A cohort of 50 patients from a 7-year period, 2003 to 2010, with chronic osteomyelitis was identified. This cohort was treated by surgical marginal resection in combination with local application of antibiotics (Collatamp G - gentamicin in a collagen fleece), a short course of systemic antibiotics post-operatively and conversion to oral antibiotics on discharge. Information was retrieved from case notes and computerized records. Outcomes from this cohort were compared with a historical cohort treated with marginal resection followed by 6 weeks of systemic antibiotics and 6 weeks of oral antibiotics.The mean follow-up duration was 3.2 years (SD 1.8). The average length of admission was 9.8 days (SD 11.4). 6 patients (12%) suffered recurrence of infection requiring further treatment. We used the Cierny and Mader classification to stratify the patients. 'A' hosts had a shorter duration of admission (7.1 days) than 'B' hosts (12.3 days). There was no significant difference between recurrence rates of 'A' and 'B' hosts. Where available, we found pre-operative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels had no correlation with disease recurrence. Disease-free probability for this cohort compared favourably with the historical cohort.We believe local administration of gentamicin in a collagen fleece is a useful component in the management of chronic osteomyelitis.

Induced membrane technique for the treatment of bone defects due to post-traumatic osteomyelitis

“… 8 Control of infection was judged using a combination of clinical findings and laboratory parameters, specifically, the absence of a sinus, pus, erythema and tenderness and normalisation of the laboratory parameters. 11 …”

Antibiotic-Loaded Collagen Sponges in Clinical Treatment of Chronic Osteomyelitis

“…A total of 813 articles were identified by various methods, and 10 studies 18,[24][25][26][27][28][29][30][31][32] were included after screening on the basis of the title and abstract (Fig. 1).…”

“…The 10 selected studies varied in study design, article type, and outcome measurements, and involved 2 different antibiotic-loaded sponges (Table I). Gentamicin-sulfate/ gentamicin-crobefate sponge was investigated in 1 RCT 25 , whereas gentamicin-sulfate sponge was investigated in the remaining 9 studies 18,24,[26][27][28][29][30][31][32] , which included 1 RCT 31 , 6 case series 18,24,26,[28][29][30] , 1 cohort study 32 , and 1 retrospective outcome study 27 (Table II).…”

“…The study by Buehler et al had a follow-up of 6 weeks because they studied the risk of early reinfection 25 . The other studies had a mean follow-up of 1 to 7.1 years because the authors were more interested in the medium to long-term rate of infection eradication 18,24,[26][27][28][29][30][31][32] . Pharmacokinetics were also studied in the first 5 to 7 days after surgery.…”

Surgical Debridement Is Superior to Sole Antibiotic Therapy in a Novel Murine Posttraumatic Osteomyelitis Model

“…aureus for 2 weeks, followed by thorough debridement and subsequent antibiotic therapy or antibiotic treatment alone respectively. In order to come closest to clinical situation, Gentamicin was used for antibiotic therapy, as it is often used for treatment of osteomyelitis [ 36 ]. Moreover adverse effects of Gentamicin on bone regeneration were described in vitro [ 37 , 38 ].…”