RESEARCH ARTICLE
Chronic Osteomyelitis - Bacterial Flora, Antibiotic Sensitivity and Treatment Challenges
Kuzma Jerzy1, *, Hombhanje Francis2
Article Information
Identifiers and Pagination:
Year: 2018Volume: 12
First Page: 153
Last Page: 163
Publisher ID: TOORTHJ-12-153
DOI: 10.2174/1874325001812010153
Article History:
Received Date: 26/1/2018Revision Received Date: 09/03/2018
Acceptance Date: 14/3/2018
Electronic publication date: 30/03/2018
Collection year: 2018
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background:
Chronic osteomyelitis is a catastrophic sequel of delayed diagnosis of acute osteomyelitis.
Objectives:
The objectives of the study were to determine bacterial flora and antibiotic sensitivity, and to evaluate the outcome of an aggressive surgical approach to chronic osteomyelitis.
Methods:
This is a single surgeon, prospective cohort study on 30 consecutive patients with clinically and radiologically diagnosed chronic osteomyelitis presented to a hospital. We prospectively recorded demographic, clinical, radiological features, treatment protocol, microbiologic results of culture and sensitivity. The main treatment outcome measures were clinical signs of eradication of infection.
Results:
Microbiologic results showed that Gram-negative and mixed flora accounts for more than half of chronic osteomyelitis cases while Staphylococcus aureus was a dominating single pathogen (39%). We detected a high resistance rate to common antibiotics, e.g. 83% of S. aureus isolates were resistant to oxacillin (MRSA). The mean duration of bone infection was 4.2 years (3 months to 30 years) and the mean number of operations was 1.5 (1-5) . The mean follow-up was 15 months (12-18 months). Infection was eradicated in 95% (21 out of 22) treated by a single procedure and in all patients (n=8) by double procedure.
Conclusion:
Presented the high rate of MRSA strains is alarming and calls for updating of the antibiotic therapy guidelines in the country. Good results in treatment of chronic osteomyelitis can be achieved by a single-stage protocol including radical debridement combined with systemic and topical antibiotic.