Pharmacotherapy of diabetic foot osteomyelitis

Diabetic foot osteomyelitis (DFO) complicates about 20% of diabetic foot infections (DFIs) and increases the risk of lower extremity amputation. This contentious infection is important to discuss, given the frequency with which diabetes mellitus and its complications occur and the devastating consequences of amputation. The diagnosis and management of DFO is complicated by the diverse presentations, delayed recognition, poorly defined diagnostic criteria, and lack of validated treatment regimens. Major issues of concern include when to undertake bone resection surgery and which antimicrobial agents to use, by what route, and for how long. Patients in whom DFO is suspected are best cared for by a multidisciplinary team, including infectious disease physicians or clinical microbiologists, orthopaedic, plastic and vascular surgeons, diabetologists, primary care physicians, podiatrists and specialist (especially tissue viability) nurses. Such multidisciplinary teams have repeatedly been shown to improve disease outcomes. We herein analyse the limited, and recently published, literature on the pharmacotherapy of DFO and put it into the broader context of management of DFI and osteomyelitis.     

创伤性胫骨骨髓炎的护理

目的探讨创伤性胫骨骨髓炎的临床护理体会。方法回顾分析本院2007年3月～2011年3月收治的28例创伤性胫骨骨髓炎患者的临床资料。结果本组28例患者跟踪随访4年,所有患者均治愈,其中2例于治疗后6个月复发,1例1年内复发,经二次感染病灶清除,以及合理的抗菌药物应用治疗后,症状消失,伤口愈合。结论通过手术彻底清除坏死病灶组织,合理地运用抗菌药物等方法进行治疗胫骨骨髓炎,疗效可靠。同时,精心细致的临床护理也是患者康复的关键。     

Drug-eluting implants for osteomyelitis

Osteomyelitis, an inflammatory process accompanied by bone destruction, is caused by infective microorganisms. The high success rates of antimicrobial therapy by conventional routes of administration in controlling most infectious diseases have not yet been achieved with osteomyelitis for several reasons. Local and sustained availability of drugs have proven to be more effective in achieving prophylactic and therapeutic outcomes. This review introduces osteomyelitis--its prevalence and pathogenesis, the present options for drug delivery and their limitations, and the wide range of carrier materials and effective drug choices, with major focus on the pharmaceutical concepts involved in drug delivery system design and development. With increasing numbers of orthopedic surgeries and the advent of combination devices that provide support and deliver drugs, local drug delivery for osteomyelitis is a topic of importance for both social and commercial interests.     

Treatment of chronic osteomyelitis with ciprofloxacin

The results of the treatment of twenty-one patients (age 22–66 years) with chronic bone or joint infections with ciprofloxacin were evaluated. The osteomyelitis was secondary to trauma in 12 patients, joint replacement in six, previous acute hematogenous infection in two and osteotomy in one.Stafylococcus aureus (11 times) andPseudomonas aeruginosa (9 times) were most frequently cultured. The duration of ciprofloxacin therapy averaged 76 days. Concomitant antimicrobial drugs were used in one patient only. Fifteen patients were operated during treatment; in most cases the surgical procedure consisted of a thorough debridement. Nineteen patients could be evaluated. The bacteriological results were as follows: eradication 27; marked reduction 1; eradication with recurrence 1. Contamination occurred in five patients and superinfection in two, without much influence on the final outcome. The investigator's assessment at the end of the therapy was as follows: complete success in 14 patients and partial success in seven. During the follow-up (3–13 months) the therapy was judged completely successful in 16, partially successful in four and unsuccessful in one. Two patients had minor gastric complaints during therapy and one showed a temporary slight increase in the liver transaminases.

     

肌皮瓣移植术治疗慢性骨髓炎

目的观察肌皮瓣移植术治疗慢性骨髓炎的疗效。方法 1999年5月—2009年12月,采用肌皮瓣移植术为主,治疗慢性骨髓炎并骨外露10例。观察肌皮瓣成活情况,颜色,质地,感觉,感染复发率。结果 10例均获得随访,随访时间1年～5年,平均3年。7例肌皮瓣全部成活。2例皮瓣远端部分坏死。1例肌肉和小部分皮肤成活。于1年时与周围皮肤颜色接近,质地柔软,早期较臃肿,6个月后逐渐变薄。感觉3个月后均有不同程度恢复,于6个月时接近正常,恢复具有保护功能的浅感觉。感染无复发。结论肌皮瓣移植术是治疗慢性骨髓炎较可靠的方法。     

Treatment of chronic postsurgical osteomyelitis with ciprofloxacin

Sixteen patients (11F, 5M, age 18–83, mean 59.8 years) with chronic postsurgical osteomyelitis were treated with ciprofloxacin. The dosage was 500 or 750 mg twice daily orally during one to six months; four patients started with 300 mg twice daily intravenously and changed after 3–7 days to oral therapy. Twelve patients had implanted prostheses. The organisms involved wereEnterobacteriaceae (11),Pseudomonas aeruginosa (7),Staphylococcus aureus (5),Streptococcus faecalis (4) andBacteroides fragilis (1). Nine patients had pure cultures, seven mixed cultures.

Cure (disappearance of infection symptoms, return of normal function with negative cultures, without resurgery) was obtained in 11 patients, improvement (resurgery required to obtain complete cure) in two. Three patients with infections byStaphylococcus aureus (2) andPseudomonas aeruginosa (1) failed to respond after one and four months treatment respectively. No side effects were observed.

     

Vertebral osteomyelitis associated with Granulicatella adiacens

Granulicatella adiacens is a nutritionally variant streptococci. Only 3 cases of vertebral osteomyelitis due to these microorganisms have been reported. We experienced a 73-year-old male who consulted us due to fever and back pain of about 1-month duration. On examination, a presystolic murmur was heard in the apical region. Echocardiography showed prolapse of the mitral valve, but no vegetation was observed. MRI revealed osteomyelitis of lumbar vertebrae. As G. adiacens was detected in blood culture, it was determined as the cause of vertebral osteomyelitis, and combination antibiotics therapy was started. The condition improved, the patient underwent valvoplasty, and no trace of infective endocarditis was noted in the resected valve. All the previous cases had infection caused by G. adiacens and complicated with infective endocarditis. This is the first case without infective endocarditis. Vertebral osteomyelitis due to NVS is very rare. Since nutritionally variant streptococci do not grow in common culture media, and since the sensitivity of isolation by standard conventional biochemical methods is low, the condition may be misdiagnosed as blood-culture-negative vertebral osteomyelitis. Therefore, the possibility of nutritionally variant streptococci infection should be considered if a patient with vertebral osteomyelitis shows a positive Gram stain but negative blood cultures.     

Treatment options for diabetic foot osteomyelitis

Introduction: Diabetic foot osteomyelitis therapeutical options are based on antibiotic therapy and surgical resection of the infected bone(s). Surgical and medical approaches of patients suffering from a diabetic foot osteomyelitis do not oppose but are complementary and need to be discussed as a tailored manner.

Areas covered: The aim of the present article is to discuss data issued from the most recent guidelines of the Infectious Diseases Society of America and the International Working Group on the Diabetic Foot on the management of the diabetic foot infection and from a search in the current literature using the terms diabetic foot osteomyelitis and treatment/therapy/therapeutical in both PubMed and Medline, restricted to the last five years.

Expert opinion: Surgical removal of the entire infected bone(s) has been considered in the past as the standard treatment but medical approach of these patients has now proven efficacy in selected situations. The current emergence of bacteria, especially among Gram negative rods, resistant to almost all the available antibiotics gradually augments the complexity of the management of these patients and is likely to decrease the place of the medical approach and to worsen the outcome of these infections in the next future.     

维吾尔族慢性骨髓炎患者56例分析

目的 对56例维吾尔族慢性骨髓炎进行临床分析.方法 对2006年1月至2008年12月入住新疆乌鲁木齐市友谊医院骨科,56例维吾尔族慢性骨髓炎患者采用分期治疗,观察治疗效果.结果 56例患者中49例(87.5%)治愈,5例复发,2例失访.结论 采用分期方法治疗维吾尔族慢性骨髓炎患者,安全有效,术后恢复良好,是治疗骨髓炎的有效方法.