Surgical management of chronic osteomyelitis:Organisms,recurrence and treatment outcome  

作　　者：Koushik Narayan Subramanyam Abhishek Vasant Mundargi Milind Vittal Prabhu K.U.Gopakumar D.S.Ankush Gowd Devagiri Raviteja Reddy 

机构地区：[1]Department of Orthopaedics,Sri Sathya Sai Institute of Higher Medical Sciences-Prasanthigram,Puttaparthi,Andhra Pradesh,515134,India [2]School of Liberal Arts,Indian Institute of Technology,Jodhpur,Rajasthan,342001,India

出　　处：《Chinese Journal of Traumatology》2023年第4期228-235,共8页中华创伤杂志（英文版）

摘　　要：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 preop-erative 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<0.001)and between index surgery and at recurrence was 23.81%(Kappa score 0.155,p<0.001).Lack of knowledge of causative organism preoperatively did not affect outcome.At mean follow-up(42±15)months,all patients were apparently infection free for at least 1 year.Conclusion:Polymicrobial growth and multi-drug resistant organisms increase the risk of recurrence in COM.Patients'age,gender,diabetes mellitus,previous failed treatment,duration of symptoms,hae-moglobin,white cell count,C-reactive protein and erythrocyte sedimentation rate at presentation did not have any impact on the recurrence of infection.Pre-operative isolation of or

关 键 词：Chronic osteomyelitis DEBRIDEMENT ANTIBIOTICS Osteomyelitis recurrence Osteomyelitis relapse 

分 类 号：R681.2[医药卫生—骨科学]