Diagnosis and treatment of osteomyelitis (original) (raw)
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Diagnosis and Treatment Modalities for Osteomyelitis
Cureus, 2022
Osteomyelitis is an infection-related inflammatory disease of the bones. Imaging and laboratory results are typically used to support a clinical diagnosis of osteomyelitis. Microbial cultures and bone biopsies provide conclusive diagnoses. The first imaging procedure that needs to be done is radiography, but its sensitivity is low in the early stages of the disease. The sensitivity of magnetic resonance imaging, both with and without contrast material, is higher for detecting areas of bone necrosis in advanced stages. Patients can be categorised for surgical treatment using a staging system based on major and minor risk factors. The main course of treatment should be antibiotics, which should be chosen depending on the findings of the culture and the characteristics of each patient. Bony debridement surgery is frequently required, and in high-risk patients or those with severe illness, additional surgical intervention can be necessary. Better outcomes are being attained in the treatment of this illness thanks to advancements in surgical treatment, antibiotic therapy, and the current resources for precise diagnosis and tailored responses to each kind of osteomyelitis. The classification systems that are most frequently employed, as well as the general epidemiological ideas, are presented together with the discussion of acute and chronic osteomyelitis. The key recommendations for diagnosing infections clinically, in the laboratory, and through imaging are covered, along with the recommendations for surgical and antibiotic procedures, and the function of hyperbaric oxygen as adjuvant therapy. We evaluate the osteomyelitis-related articles, summarise the most recent developments in diagnostic procedures and therapeutic regimens, evaluate the benefits and drawbacks of various diagnostic modalities and therapeutic approaches, and suggest areas of focus to help current diagnostic and therapeutic approaches.
The outcome of treatment of chronic osteomyelitis according to an integrated approach
Strategies in trauma and limb reconstruction (Online), 2016
Previous classification systems of chronic osteomyelitis have failed to provide objective and pragmatic guidelines for selection of the appropriate treatment strategy. In this study, we assessed the short-term treatment outcome in adult patients with long-bone chronic osteomyelitis prospectively where a modified host classification system was integrated with treatment strategy selection through a novel management algorithm. Twenty-six of the 28 enrolled patients were available for follow-up at a minimum of 12 months. The median patient age of was 36.5 years (range 18-72 years). Fourteen patients (54 %) were managed palliatively, and 11 patients (42 %) were managed through the implementation of a curative treatment strategy. One patient required alternative treatment in the form of an amputation. The overall success rate was 96.2 % (95 % CI 80.4-99.9 %) at a minimum of 12-months follow-up. Remission was achieved in all [11/11] patients treated curatively (one-sided 95 % CI 73.5-100.0...
The management of osteomyelitis in the adult
Bone infection Clinical management a b s t r a c t Background and purpose: Osteomyelitis (OM) is considered one of the most challenging medical conditions an orthopaedic surgeon has to face. Much debate is present concerning diagnosis and treatment, especially about differences between acute and chronic forms of the condition. The main aim of the present work is to show the key points where research should be implemented. Methods: Online database were searched to find evidence about the clinical management of osteomyelitis. Clinical randomized trials, case series, prospective cohort studies reporting on diagnosis and treatment of acute and chronic osteomyelitis were taken into consideration. Cadaveric studies, laboratory studies, case reports, review articles and metaanalyses were excluded. Furthermore, studies concerning implant related OM were excluded. Studies in English, Spanish and French were considered in this process of inclusion. The cohorts of all the included studies were composed of adult patients.
Causes and Management of Osteomyelitis
2019
Introduction: Depending on the infection's particular features (etiology, pathogenesis, extent of bone involvement, and duration) and the patient (infant, child, adult, or immunocompromised) a variety of challenges is present of osteomyelitis in long bones. Tremendous progress was made in the four past decades in the treatment of osteomyelitis as the many factors that account for the occurrence and persistence of infection have been found and a variety of antimicrobials with other spectrums of activity against microbes have been developed.
OSTEOMYELITIS: FROM DIAGNOSIS TO TREATMENT (Atena Editora)
OSTEOMYELITIS: FROM DIAGNOSIS TO TREATMENT (Atena Editora), 2023
This study aimed to carry out a bibliographic review about Osteomyelitis, a bone inflammation caused by an infection. Since 1984, osteomyelitis has been known, which is a bone inflammation due to a constant infection process, which occurs when a pathogen has access to the bone through an exposed wound, or resulting from trauma or a post-surgical procedure. To make the diagnosis, when the individual presents signs and symptoms (fever, chills, abscesses, edema and local erythema), which can be localized or systemic. We identified it through alterations in an X-ray exam, also requiring complementary exams. This pathology has different classifications, but with a standard initial treatment, with the use of drugs and even surgical intervention in more severe cases. The highlight is given to the group most affected by the pathology, men, whites aged over 60 years are the most seriously affected. This way, it is necessary to give due importance to carrying out more research and forms of prevention for this pathology and its consequences.
Recommendations for the treatment of osteomyelitis
The Brazilian Journal of Infectious Diseases, 2014
Keywords: Osteomyelitis Bone and joint infection Soft tissue infection Infectious diseases a b s t r a c t With the advances in surgical treatment, antibiotic therapy and the current resources for accurate diagnosis and differentiated approaches to each type of osteomyelitis, better results are being obtained in the treatment of this disease. After a careful literature review carried out by a multiprofessional team, some conclusions were made in order to guide medical approach to different types of osteomyelitis, aiming to obtain better clinical outcomes and reducing the social costs of this disease. Acute and chronic osteomyelitis are discussed, with presentation of the general epidemiological concepts and the commonly used classification systems. The main guidelines for the clinical, laboratory and imaging diagnosis of infections are discussed, as well as the guidelines for surgical and antimicrobial treatments, and the role of hyperbaric oxygen as adjuvant therapy. (P.R. Oliveira). ♦ The members of the Diretrizes Panamericanas para el Tratamiento de las Osteomielitis e Infecciones de Tejidos Blandos Group are listed in Appendix A.
Pathogenetic features of chronic osteomyelitis treatment
Genij Ortopedii, 2021
Over the past decades, there has been a steady increase in the incidence of osteomyelitis. It is associated with an increased use of implants in traumatology and orthopedics. The social aspects of osteomyelitis are, on the one hand, significant financial costs for the healthcare system, and on the other hand, high recurrence and re-infection in the treatment of joint pathology associated with long-term loss of work ability and a high risk of patient’s disability. Purpose To conduct a search and analysis of publications in Russian and English, devoted to the problem of osteomyelitis and periprosthetic infection, on the basis of which to summarize the main current notions about the etiology, pathogenesis, diagnosis and treatment of osteomyelitis. Materials and methods The search was carried out in the Pubmed and CyberLeninka databases of literature sources over the past 10 years. The data were analyzed and compared with the materials from earlier publications. Only publications from p...
The management of chronic osteomyelitis: Part I – Diagnostic work-up and surgical principles
To date, no evidence-based guidelines for the treatment of chronic osteomyelitis exist. Owing to certain similarities, treatment philosophies applicable to musculoskeletal tumour surgery may be applied in the management of chronic osteomyelitis. This novel approach not only reinforces certain important treatment principles, but may also allow for improved patient selection as surgical margins may be customised according to relevant host factors. When distilled to its most elementary level, management is based on a choice between either a palliative or curative approach. Unfortunately there are currently no objective criteria to guide selection of the most appropriate treatment pathway.
Standard versus Specific Therapy for Chronic Osteomyelitis Treatment
American Journal of Infectious Diseases, 2007
58 patients with chronic osteomyelitis were treated either with a standard therapy or with a specific targeted therapy based on the antibiogram assay. Standard therapy was performed by a 15-day course of a parenteral cephalosporin (usually ceftriaxone) in combination with an aminoglycoside (e.g. netilmicin), followed by oral therapy with a fluoroquinolone (generally ciprofloxacin) for 1 to 3 months; specific therapy largely varied depending on the antibiogram response. The results indicated that no significant differences were found between the patients who received standard therapy (95.5 % cured) and those who received a specific therapy (93.5 % cured), after a one year follow-up. It can be concluded that a short-term combined parenteral-oral standard therapy, indicated in all those cases where antibiotic therapy must be started before obtaining the laboratory response, or when a clear and definite identification of the microorganisms involved in the infection is not possible, can be as efficient as an antibiogram-guided therapy in the treatment of chronic osteomyelitis.
Journal of Chemotherapy, 2006
Clinical trials of systemic antibiotic treatment of osteomyelitis are difficult to perform for many reasons, such as low incidence rate of osteomyelitis, variety of anatomic locations, stage and etiologic agents. In this article, we reviewed the experimental studies on osteomyelitis available in the English medical literature since 1968, to ascertain their actual and potential impact on the treatment of human osteomyelitis. Major results are summarized and topics of major interest, such as reproducibility of animal models, predictive value of animal models, correlation of pharmacokinetics between different animals and humans, and the correlation of outcome between animal and clinical studies are discussed. Most of the reviewed animal models are reproducible and dependable. However, establishing the right dose regimen in animals appeared a critical factor, which might undermine the predictive value of the experimental study. Due to difficulties in comparing results of animal and human studies, the predictive value of animal studies about osteomyelitis is still unclear. However, animal models gave valuable information to the clinician for choosing the minimal duration of antibiotic treatment. Even though the use of antibiotic combinations was associated with better outcome in the majority of animal studies, such a finding seems to have limited impact on clinical practice.