Chronic Osteomyelitis - Pathophysiology and Treatment.

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Abstract

Conflict of interest statement: The authors declare that they have no conflict of interest. 7. Chin J Traumatol. 2023 Jul;26(4):228-235. doi: 10.1016/j.cjtee.2023.01.003. Epub 2023 Jan 31. Surgical management of chronic osteomyelitis: Organisms, recurrence and treatment outcome. Subramanyam KN(1), Mundargi AV(2), Prabhu MV(2), Gopakumar KU(3), Gowda DSA(2), Reddy DR(2). Author information: (1)Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences - Prasanthigram, Puttaparthi, Andhra Pradesh, 515134, India. Electronic address: koushik.n@sssihms.org.in. (2)Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences - Prasanthigram, Puttaparthi, Andhra Pradesh, 515134, India. (3)School of Liberal Arts, Indian Institute of Technology, Jodhpur, Rajasthan, 342001, India. PURPOSE: The study aimed to identify the risk factors of recurrence in chronic osteomyelitis (COM) and to document the microbiological patterns pre- and intra-operatively and at recurrence, if any. METHODS: We performed retrospective review on COM patients treated with surgical debridement and a 6-week course of antibiotics. The patients with symptoms of osteomyelitis for at least 6 weeks, present or past episodes of discharging sinus, documentation of bone sequestration in operative notes or preoperative images were included in the study. Patients with symptoms of osteomyelitis < 6 weeks, lack of history of discharging sinus or lack of evidence of sequestration in preoperative images or intraoperative notes were excluded. Logistic regression models were used to assess the impact of risk factors of recurrence. Cohen-Kappa scores were derived to see the concordance between pre-operative and intra-operative isolates and at recurrence. RESULTS: Totally, 147 COM patients (115 males and 32 females, mean age (33 ± 19) years) were included in this study. Recurrence was noted in 28 patients (19.0%). Polymicrobial growth and extended spectrum beta-lactamase producing Enterobacteriaceae increased the chance of recurrence. Cierny-Mader stage-1, hematogenous aetiology and negative intraoperative culture reduced the chance of recurrence. Concordance between pre-operative and intra-operative cultures was 59.85% (Kappa score 0.526, p