Oral ciprofloxacin compared with standard parenteral antibiotic therapy for chronic osteomyelitis in adults

A group of fourteen patients who had chronic osteomyelitis and were treated with oral ciprofloxacin was compared with a group of twelve patients of similar age who had chronic osteomyelitis and received standard parenteral antibiotic therapy consisting of nafcillin, clindamycin, and gentamicin, singly or in combination. The osteomyelitis was arrested at the end of therapy and on follow-up examination of eleven patients in the first group and ten in the second group. The average duration of antibiotic therapy (thirty-eight days) and follow-up (approximately thirty months) were about the same for both groups. Oral administration of ciprofloxacin was as effective and safe as parenteral therapy for the treatment of osteomyelitis in these adults.     

Aspergillosis osteomyelitis and joint infection in a renal transplant recipient

Invasive Aspergillosis occurs in almost every human organ, most commonly in the lungs. Bone involvement classically has been considered exceedingly rare for both immunocompromised and immunocompetent hosts, however, there are limited data in transplant recipients. We report an unusual case of osteomyelitis and joint infection of the ankle caused by Aspergillus fumigatus in a renal transplant recipient.     

负压治疗技术在急、慢性骨感染中的应用

目的 探讨负压治疗技术在治疗急、慢性骨感染中的价值.方法 采用负压治疗技术.即在一段时间内将伤口置于密闭强力负压状态,治疗急、慢性骨感染患者30例(33个部位),辅助清创手术,应用敏感抗生素,应用植皮、肌皮瓣转移等方法闭合创面.结果 29个部位通过1次负压治疗就可达到创面闭合条件.所有患者均获随访,随访时间6～23个月,平均13.6个月,感染无复发.结论 负压治疗技术能有效控制急、慢性骨感染,缩短治疗时间,在骨感染治疗中有较好的应用前景.     

Syndromes with chronic non-bacterial osteomyelitis in the spine

Chronic non-bacterial osteomyelitis (CNO) has been known for over of 40 years. It is an underrecognized entity due to the low number of described cases and poor propagation awareness of the problem. Chronic non-bacterial osteomyelitis is usually confused with infectious spondylodiscitis or malignant lesions, both primary and metastatic. Failing to consider CNO as one of possible lesions of the spine among an array of differential diagnoses may lead to a prolonged ineffective treatment increasing treatment-related morbidity. In this paper the authors describe these two syndromes, with a possible autoimmune background – chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO syndrome – that include CNO being among the manifestations. The authors present the spinal symptomatology of CNO for both syndromes published so far to help spine clinicians organize the information for better usage in everyday clinical practice.     

Comparative evaluation in the treatment of chronic post-traumatic osteomyelitis of the lower leg: free flaps compared with local flaps

Forty-nine out of 101 patients treated for post-traumatic chronic osteomyelitis of the lower leg at the Innsbruck University Hospital for Plastic and Reconstructive Surgery in Austria between 1979 and 1996 were included in this retrospective study. The following parameters were covered in the statistic evaluation: postoperative complications, rates of flap survival, recurrence and revision, nosocomial infections, duration of hospitalisation, chronic oedema of the lower leg, and patient satisfaction. Postoperative complications, recurrence, and flap loss rates were significantly lower in the free-flap group. These low rates are most likely responsible for the significantly shorter hospitalisation of patients treated with free flaps. For these reasons, their use may be considered first-choice therapy in the treatment of chronic post-traumatic osteomyelitis of the lower leg.     

Treatment of chronic osteomyelitis of the acetabulum after hip joint replacement with a glutaeus maximus muscle flap

Summary We report on a 65-year-old man who was sent to our clinic with osteomyelitis of the hip combined with a chronic external fistula after hip joint replacement followed by several further operations including amputation of the leg. After complete removal of the fistula and repeated vacuum sealing of the wound, we used a vasculated glutaeus maximus muscle flap to close the defect. The course after the operation was without any complications. The method applied led to sufficient treatment of the osteomyelitis without weakening the trunk muscles or rendering the use of crutches more difficult.      

Spatiotemporal pattern of macrophage recruitment after chronic nerve compression injury

The contribution of macrophages to the pathogenesis of chronic nerve compression (CNC) injuries is presently unclear. We examined the time course and spatial localization of macrophage invasion from 24 hours to 28 days post-CNC injury with immunohistochemistry (IHC) and electron microscopy (EM). To clarify the differences in macrophage activity between different peripheral nerve injuries, we compared CNC injury to a nerve crush (CR) injury at similar time points. Entire counts of macrophages with ED1-immunoreactivity (IR) showed a slow, gradual increase in macrophage number from 24 hours to 28 days post-operatively in compressed sections. ED1-IR was greatest at the site of compression and in distal nerve segments with minimal immunostaining in proximal and normal sections. Quantitative analysis of ED1-IR after crush injury demonstrated a rapid time course of macrophage recruitment with ED1-IR peaking at 48 hours and declining to normal values as early as 21 days post-CR injury. Ultrastructural analysis with EM 14 days post-CNC injury revealed greater macrophage localization in the inner one-third region of normal nerves relative to the outer region. Differences in macrophage localization within inner and outer regions of compressed sections were negligible, as macrophages were found diffusely throughout the endoneurium by day 14. Our findings suggest that macrophage recruitment is dependent upon proximity to neural vasculature with relative macrophage density highest specifically around endoneurial blood vessels in both normal and compressed sections. Taken together, our results detail the unique spatiotemporal dynamics of macrophage recruitment early after CNC injury as distinct from a crush injury.     

Psychosocial problems in patients with chronic osteomyelitis

52 patients suffering from a chronical bone infection were followed up with a special interest in psychosocial problems. In all cases psychosocial disturbances of different importance were evaluated. Possible causes have to be seen in long time of hospitalisation (average = 304 days), and apparent inadequate enlightenment of patients and in functionally and cosmetically insufficiencies. Conclusions are shown for the management in treatment of chronical bone infections.     

Prognosis of the transition of acute hematogenous osteomyelitis to it chronic form in children

Examined were 134 children with acute hematogenous osteomyelitis. It was established, that the different outcomes of acute hematogenous osteomyelitis were conditioned by the different in quality variants of the course of the disease with originality of immunologic reactions. In transition of acute hematogenous osteomyelitis to the chronic form at the period of stabilization of acute inflammation in patients, the number of T- and B-lymphocytes, the index of completed phagocytosis remains significantly decreased, and the lysozyme and IgG content of the blood serum--significantly increased.     

Efficacy of moxifloxacin compared to teicoplanin in the treatment of implant‐related chronic osteomyelitis in rats

Treatment of implant‐related chronic osteomyelitis is often difficult and usually consists of implant removal, extensive surgical debridement, and prolonged antibiotic use. This study was performed to assess the efficacy of moxifloxacin compared to a glycopeptide, teicoplanin in chronic implant‐related methicillin‐sensitive Staphylococcus aureus (MSSA) osteomyelitis. The left femoral medullar cavities of 60 Wistar male rats were contaminated with 100 µl of 10⁸ cfu/ml methicillin‐sensitive S. aureus (ATCC 29213) and Kirschner wires were placed into the medulla of the femur. After 6 weeks, rats were randomly divided into five groups. In two groups, the Kirschner wires were removed. Experimental groups were as follows: group 1: contaminated, Kirschner wire inside, received teicoplanin; group 2: contaminated, Kirschner wire removed, received teicoplanin; group 3: contaminated, Kirschner wire inside, received moxifloxacin; group 4: contaminated, Kirschner wire removed, received moxifloxacin; group 5: contaminated, Kirschner wire inside, no antibiotics (control group). Groups 1 and 2 received teicoplanin (20 mg/kg once daily), whereas groups 3 and 4 received moxifloxacin (10 mg/kg twice daily) intraperitoneally for 28 days. At the end of the treatment, animals were sacrificed by inhalation anesthesia with ether and femora were retrieved and bacterial counts (cfu/g) were determined. Bacterial counts in all study groups were significantly reduced relative to the control. The decrease of bacterial counts was more prominent in group 4 compared to group 1 (p = 0.001) and group 2 (p = 0.003). Moxifloxacin therapy is an effective alternative to teicoplanin for chronic implant‐related MSSA osteomyelitis. Published by Wiley Periodicals, Inc. J Orthop Res 28:1368–1372, 2010