The management of osteomyelitis in the adult

Maffulli, Nicola; Papalia, Rocco; Zampogna, Biagio; Torre, Guglielmo; Albo, Erika; Denaro, Vincenzo

doi:10.1016/j.surge.2015.12.005

Cited by 96 publications

(84 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Bone provides a unique harbor for microorganisms, allowing them to attach to (and colonize) biologic and surgically implanted surfaces while remaining insusceptible to host defenses and antimicrobials [2]. Prolonged courses of antibiotic therapy in conjunction with surgical debridement are mainstays of chronic osteomyelitis therapy in orthopedics [3]. However, antibiotics in general have poor bone penetration and pharmacokinetic bioavailability in bone, which creates additional therapeutic challenges.…”

Section: Introductionmentioning

confidence: 99%

Bad to the Bone: On In Vitro and Ex Vivo Microbial Biofilm Ability to Directly Destroy Colonized Bone Surfaces without Participation of Host Immunity or Osteoclastogenesis

et al. 2017

View full text Add to dashboard Cite

Bone infections are a significant public health burden associated with morbidity and mortality in patients. Microbial biofilm pathogens are the causative agents in chronic osteomyelitis. Research on the pathogenesis of osteomyelitis has focused on indirect bone destruction by host immune cells and cytokines secondary to microbial insult. Direct bone resorption by biofilm pathogens has not yet been seriously considered. In this study, common osteomyelitis pathogens (Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, and Streptococcus mutans) were grown as biofilms in multiple in vitro and ex vivo experiments to analyze quantitative and qualitative aspects of bone destruction during infection. Pathogens were grown as single or mixed species biofilms on the following substrates: hydroxyapatite, rat jawbone, or polystyrene wells, and in various media. Biofilm growth was evaluated by scanning electron microscopy and pH levels were monitored over time. Histomorphologic and quantitative effects of biofilms on tested substrates were analyzed by microcomputed tomography and quantitative cultures. All tested biofilms demonstrated significant damage to bone. Scanning electron microscopy indicated that all strains formed mature biofilms within 7 days on all substrate surfaces regardless of media. Experimental conditions impacted pH levels, although this had no impact on biofilm growth or bone destruction. Presence of biofilm led to bone dissolution with a decrease of total volume by 20.17±2.93% upon microcomputed tomography analysis, which was statistically significant as compared to controls (p <0.05, ANOVA). Quantitative cultures indicated that media and substrate did not impact biofilm formation (Kruskall-Wallis test, post-hoc Dunne’s test; p <0.05). Overall, these results indicate that biofilms associated with osteomyelitis have the ability to directly resorb bone. These findings should lead to a more complete understanding of the etiopathogenesis of osteomyelitis, where direct bone resorption by biofilm is considered in addition to the well-known osteoclastic and host cell destruction of bone.

show abstract

Section: Introductionmentioning

confidence: 99%

Bad to the Bone: On In Vitro and Ex Vivo Microbial Biofilm Ability to Directly Destroy Colonized Bone Surfaces without Participation of Host Immunity or Osteoclastogenesis

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Antibiotic therapy is the first-choice treatment for acute OM, while debridement is indicated in chronic OM [36]. In infants, however, OM tends to occur in the site of the metaphysis, which has a potential risk of physeal plate injury.…”

Section: Discussionmentioning

confidence: 99%

Clinical experience of debridement combined with resorbable bone graft substitute mixed with antibiotic in the treatment for infants with osteomyelitis

Zhang¹,

Li²,

Li³

et al. 2018

J Orthop Surg Res

View full text Add to dashboard Cite

BackgroundOsteomyelitis (OM) is an uncommon disease that originates from many different mechanisms in children. Treatment often involves a combination of surgical debridement combined and antibiotic therapy. The purpose of this article is to evaluate the effect of debridement combined with a new resorbable bone graft substitute (RBGS) mixed with antibiotics in the treatment of infants with OM.MethodsTwenty-two patients diagnosed with OM at our institution underwent debridement combined with implantation of RBGS mixed with vancomycin within 48 h after admission. Clinical and epidemiological factors, preoperative and postoperative radiographs, and laboratory parameters, including white blood cell (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil percentage (NEU%), were documented. The function of the involved extremity was evaluated at the final follow-up.ResultsThe mean age was 6.3 ± 4.8 months (range, 0.5 to 12 months). The mean duration of the symptoms was 14.5 ± 8.4 days (range, 2 to 30 days). The average length of hospitalization was 13.7 ± 6.2 days (range, 6 to 28 days). 13.64% (3/22) had positive results of purulent material obtained at the time of open biopsy and 18.18% (4/22) had positive blood cultures. The most common sites were located in the proximal femur (12), the distal femur (3), and the proximal humerus (3). Ten patients presented with concurrent pyogenic arthritis, while another 12 infants suffered from simple isolated hematogenous OM. The mean follow-up time was 3.0 ± 1.6 years (range, 1.0 to 6.0 years). Seven of 22 patients (31.82%) had complications such as limb length deformity (LLD), avascular necrosis (AVN), and pathologic subluxation of the hip. Fifteen out of 22 (68.18%) patients achieved good results. Additionally, patients who had concomitant pyogenic arthritis were more likely to develop complications than those with isolated OM (p = 0.02).ConclusionsEarly debridement combined with implantation of RBGS mixed with vancomycin in the treatment of infants with OM achieved acceptable results in this series. Compared to those with simple isolated OM, patients with secondary pyogenic arthritis had a more virulent course.

show abstract

“…2 As a result, costs and bone-related medical treatments increase constantly. 3 Also, as a consequence of injuries, it is possible to incur large-sized fractures called critical-size defects (CSD) since the bone lesion is so severe that it prevents the skeletal segment from self-repairing. 4 Recovery of significant skeletal defects could be partially abortive due to the perturbations that affect the regenerative process.…”

Section: Introductionmentioning

confidence: 99%

Scleral ossicles: angiogenic scaffolds, a novel biomaterial for regenerative medicine applications

et al. 2020

View full text Add to dashboard Cite

show abstract

The management of osteomyelitis in the adult

Cited by 96 publications

References 44 publications

Bad to the Bone: On In Vitro and Ex Vivo Microbial Biofilm Ability to Directly Destroy Colonized Bone Surfaces without Participation of Host Immunity or Osteoclastogenesis

Bad to the Bone: On In Vitro and Ex Vivo Microbial Biofilm Ability to Directly Destroy Colonized Bone Surfaces without Participation of Host Immunity or Osteoclastogenesis

Clinical experience of debridement combined with resorbable bone graft substitute mixed with antibiotic in the treatment for infants with osteomyelitis

Scleral ossicles: angiogenic scaffolds, a novel biomaterial for regenerative medicine applications

Contact Info

Product

Resources

About