Epidemiological trends of empirical or microbiologically documented treatment of chronic osteomyelitis. Results from a ten-year survey at a reference bone and joint infectious diseases department
Abstract number: P1526
Giannitsioti E., Papadopoulos A., Athanasia S., Koratzanis E., Drakou A., Papagelopoulos P., Panagopoulos P., Plachouras D., Giamarellou H., Kanellakopoulou K.
Background: Chronic osteomyelitis (CO) is a treatment challenge for ID specialists as the optimal regimen and treatment duration are still not fully established.
Methods: We retrospectively analyzed 144 CO cases, documented upon clinical, radiological, histology and available microbiological data. Cases were retrieved from a data-base registry of all patients with bone and joint infections followed in our Department during the last decade. Only pathogens isolated either from intra-operative or bone aspiration samples were included. CO cases treated either empirically (ET) or upon microbiological documentation (MT) were comparatively assessed. Duration of treatment was individualised. Predictors of treatment failure were analyzed. Treatment failure was the absence of clinical, radiological and microbiological resolution of the infection.
Results: From 144 CO eligible cases, 105 (73%) were male. Median (IQR) age was 48 (3163) years, and median (IQR) duration of treatment was 6 (410) months. Surgical debridment was performed in 90/144 cases (65.3%). Distribution of aetiology in the MT group (117/144, 81.2%) was as follows: MRSA (21.3%), MSSA (22.2%), CoNS (12.8%), P. aeruginosa (11.1%), other Gram negative (12.8%), Gram positive (6%) and polymicrobial infection (9%). In the ET group ciprofloxacin along with either rifampicin or clindamycin was administered in 17/27 cases (63%), while glycopeptides only in 3/27 ones (11.1%). Patients in the ET group were older (>60 years, p = 0.05), with more comorbidities (p = 0.007) less often sinus tract (p = 0.003), more clindamycin use (p = 0.01) and less surgical debridment (p = 0.01) compared to patients in the MT group. No difference in treatment duration (p = 0.9), side effects (p = 1.0) and rates of treatment failure (37/117, 31.6%, vs 6/2, 22.2%, p = 0.5) was assessed between MT and ET group. Overall, side effects (n = 38/144, 26.3%) were mostly related to SMX-TMP administration (n = 16). Regarding predictors of outcome, only fever (OR 2.8, 95% CI 0.98.3, p = 0.03) and the relatively short (3months) duration of treatment (OR 1.8, 95% CI 1.03.0, p = 0.05) were found to predict treatment failure.
Conclusions: Treatment duration more than 3 months appears to be the most important factor related to the remission of the infection regardless of ET or MT antimicrobial treatment of CO. Cautious choice of an empirical combined antimicrobial treatment in a selected population with CO may lead to a favourable clinical outcome of the infection.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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