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Materials Science & Engineering. C,... Oct 2016A new era of osteomyelitis treatment has been taking strides towards efficient, local administration of antibiotics at the site of infection. By having them localized to... (Review)
Review
A new era of osteomyelitis treatment has been taking strides towards efficient, local administration of antibiotics at the site of infection. By having them localized to the site of infection, this toxicity is no longer an issue and actually has shown to be a more productive treatment for osteomyelitis. Researchers have focused the production of non-biodegradable, antibiotic, infused bone cements specifically designed for proficient osteocyte binding, useful antibiotic release over a desirable period of time, and promotion of bone regeneration. These cements are then surgically placed on the infected site following debridement and irrigation. The problem, however, is that the use of ineffective cements and the overuse of antibiotics has led to the development of resistant bacteria. Due to this, further research is being done in the field of antibiotic discovery and delivery. Specifically, the development of biodegradable materials capable of efficiently delivering antibiotics and also eliminating the need for follow-up surgery to remove the delivery material is being done, thus reducing exposure risk. Nanoparticles have been developed in the forms of scaffolds and injections to deliver a higher degree and longer lasting duration of antibiotic release, while promoting bone regeneration.
Topics: Animals; Anti-Bacterial Agents; Bone Cements; Delayed-Action Preparations; Humans; Nanostructures; Osteocytes; Osteomyelitis
PubMed: 27287180
DOI: 10.1016/j.msec.2016.04.062 -
Pediatric Rheumatology Online Journal Jan 2022The aim of this study was to evaluate demographic, clinical, laboratory, imaging, histopathology characteristics, and treatment responses of children with Chronic...
OBJECTIVE
The aim of this study was to evaluate demographic, clinical, laboratory, imaging, histopathology characteristics, and treatment responses of children with Chronic nonbacterial osteomyelitis (CNO).
METHODS
Retrospective multi-center case series study of pediatric patients diagnosed with CNO treated at five tertiary centers in south China.
RESULTS
Totally there were 18 patients diagnosed as CNO between 2014 and 2020. The median age of onset was 9.2 years (range 3.7-13.1) and 55.6% were female. Median delay in diagnosis was 10.9 months (range 1.0-72.0). The most frequent presenting symptoms were bone pain (100%) and fever (44.4%). Most patients had more than one lesion (median of 5, range 1-7). Most frequently affected bones were tibiofibula (88.9%) and femur (77.8%). The MRI characteristics mainly presented as bone edema and hyperintensity in bone marrow. Bone biopsy was conducted in 11 patients (61.1%) with inflammatory cells infiltration manifested as chronic osteomyelitis, and none showed bacterial infection or tumor. In treatment, non-steroid anti-inflamatory drugs (NSAIDs) is used as the first-line drug followed by steriods, methotexate (MTX), salazosulfadimidine (SASP), Bisphosphonates and TNF-α inhibitor. Two refractory cases received combination therapy with Bisphosphonates and TNF-α inhibitor, and achieved good therapeutic effect.
CONCLUSIONS
The present study described a multicenter series of CNO from south China and highlighted the clinical features, laboratory tests, imaging characteristics and treatment outcomes. Increasing awareness of this disease is important to decrease time to diagnosis, improve access to treatment, and reduce complications.
Topics: Adolescent; Child; Child, Preschool; China; Female; Humans; Male; Osteomyelitis; Pain Measurement; Retrospective Studies
PubMed: 34980193
DOI: 10.1186/s12969-021-00657-4 -
The Indian Journal of Medical Research Jan 2022
Topics: Humans; Osteomyelitis; Osteopetrosis
PubMed: 35859433
DOI: 10.4103/ijmr.IJMR_2340_20 -
Tidsskrift For Den Norske Laegeforening... May 2019Osteomyelitis was determined in two patients following radiofrequency turbinoplasty. This is a rare complication of the procedure, and we have found no other case...
BACKGROUND
Osteomyelitis was determined in two patients following radiofrequency turbinoplasty. This is a rare complication of the procedure, and we have found no other case reports concerning osteomyelitis as a specific complication of radiofrequency turbinoplasty.
CASE PRESENTATION
Two patients underwent radiofrequency turbinoplasty. Postoperatively they presented with clinical features such as a faecal smell in the nose, crusting and local necrosis of the inferior turbinates, which led to the clinical and histological diagnosis of osteomyelitis. The infections were polymicrobial, as verified by bacterial growth in the nasal biopsies. They were treated with surgical debridement, local and systemic antibiotics and nasal saline irrigation.
INTERPRETATION
The patients underwent surgery that involved the use of more insertion channels than recommended by the distributor of the surgical equipment, and local anaesthesia included adrenaline. These two factors may well have caused or increased the likelihood of developing osteomyelitis. One patient has an open nose giving rise to no concern after treatment; the other patient has developed empty nose syndrome on the right side. We report these cases in order to raise and aid awareness regarding this possible complication of radiofrequency turbinoplasty.
Topics: Adult; Female; Humans; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Radiofrequency Therapy; Rhinoplasty; Turbinates
PubMed: 31140260
DOI: 10.4045/tidsskr.18.0843 -
Frontiers in Cellular and Infection... 2022Fungal osteoarticular infection (FOI) is not commonly seen in clinical practice but proposes a great challenge to orthopedic surgeons. In this study, we aimed to...
BACKGROUND
Fungal osteoarticular infection (FOI) is not commonly seen in clinical practice but proposes a great challenge to orthopedic surgeons. In this study, we aimed to investigate the risk factors, the clinical features, and surgical outcomes of FOI in our institution. Specifically, we aimed to explore the role of metagenomic next-generation sequencing (mNGS) in the diagnosis and treatment of FOI.
METHODS
All the patients who were diagnosed and managed with FOI in our institution from January 2007 to December 2020 were retrospectively reviewed, including primary fungal implant-related infection, primary fungal osteomyelitis or arthritis, and fungal infections secondary to bacterial osteomyelitis or implant-related bacterial infections. The potential risk factors and the clinical and surgical features were analyzed. The pathogen data were compared between culture and the mNGS test.
RESULTS
A total of 25 patients were included, namely, 12 primary implant-related infections, 7 primary fungal osteomyelitis or arthritis, and 6 fungal infections secondary to bacterial osteomyelitis or implant-related bacterial infections. Most cases had undergone multiple surgeries or long-term antibiotic treatment. Diagnosis was mainly based on microbial culture and the mNGS test. Optimization of culture methods and the use of mNGS assisted the diagnosis. Specifically, mNGS was performed in 12 patients, 5 of whom were culture-negative. In the remaining seven cases, mNGS demonstrated the same results as culture. Management of FOI was complicated as most patients required multiple surgeries followed by long-term antifungal treatment. In selected cases, antifungal-impregnated cement spacer retention can be an optional choice. The overall success rate was 100% (25/25) for our cohort.
CONCLUSION
We concluded that patients with comorbidities and a history of multiple surgeries or long-term antibiotics are under higher risk for FOI. Use of mNGS assists the diagnosis and treatment of FOI. Surgery combined with long-term antifungal treatment achieved satisfactory outcomes. In selected cases, antifungal-impregnated cement spacer retention can be an optional treatment choice.
Topics: Humans; Retrospective Studies; Metagenomics; Metagenome; Mycoses; Antifungal Agents; Osteomyelitis; Arthritis; Postoperative Complications; Anti-Bacterial Agents
PubMed: 36506031
DOI: 10.3389/fcimb.2022.1072539 -
Jornal de Pediatria 2024Signs and symptoms of osteomyelitis or septic arthritis in neonates and infants are often nonspecific and early-stage bone infections in infants may often go unnoticed....
OBJECTIVE
Signs and symptoms of osteomyelitis or septic arthritis in neonates and infants are often nonspecific and early-stage bone infections in infants may often go unnoticed. The objective of this study was to analyze the clinical characteristics of newborns and infants with osteomyelitis and septic arthritis to improve understanding of the disorder and to assist clinicians with diagnosis.
METHODS
A retrospective multicenter study was conducted on neonates (0-28 days old, n = 94) and infants (1-12 months old, n = 415) with osteoarticular infections. Data consisting of clinical characteristics, complications, laboratory outcomes, and the pathogenic microorganisms causing osteomyelitis were tabulated. The statistics were further broken down into two regions and the significant differences between neonates and infants were evaluated and compared to the literature.
RESULTS
Compared to infants, neonates had significantly lower incidences of fever (p < 0.0001), higher incidences of localized swelling (p = 0.0021), higher rate of infection at the humerus (p = 0.0016), higher percentage of Escherichia coli (p < 0.0001) and Klebsiella pneumoniae (p = 0.0039) infections, lower percentage of Staphylococcus aureus infections (p < 0.0001) and were more likely to develop septic arthritis (p < 0.0001).
CONCLUSION
Distinct differences were found between neonatal and infants with osteoarticular infections. Future studies should focus on improving diagnosis and subsequent treatment regimens for younger age groups.
Topics: Humans; Osteomyelitis; Arthritis, Infectious; Retrospective Studies; Infant, Newborn; Infant; Male; Female; Staphylococcal Infections
PubMed: 38642591
DOI: 10.1016/j.jped.2024.03.003 -
Pediatric Rheumatology Online Journal Dec 2017Chronic Non-Bacterial Osteomyelitis (CNO) is an inflammatory disorder that primarily affects children. Although underestimated, its incidence is rare. For these reasons,... (Review)
Review
BACKGROUND
Chronic Non-Bacterial Osteomyelitis (CNO) is an inflammatory disorder that primarily affects children. Although underestimated, its incidence is rare. For these reasons, no diagnostic and no therapeutic guidelines exist. The manuscript wants to give some suggestions on how to deal with these patients in the every-day clinical practice.
MAIN BODY
CNO is characterized by insidious onset of bone pain with local swelling. Systemic symptoms such as fever, skin involvement and arthritis may be sometimes present. Radiological findings are suggestive for osteomyelitis, in particular if multiple sites are involved. CNO predominantly affects metaphyses of long bones, but clavicle and mandible, even if rare localizations of the disease, are very consistent with CNO diagnosis. CNO pathogenesis is still unknown, but recent findings highlighted the crucial role of cytokines such as IL-1β and IL-10 in disease pathogenesis. Moreover, the presence of non-bacterial osteomyelitis among autoinflammatory syndromes suggests that CNO could be considered an autoinflammatory disease itself. Differential diagnosis includes infections, malignancies, benign bone tumors, metabolic disorders and other autoinflammatory disorders. Radiologic findings, either with Magnetic Resonance or with Computer Scan, may be very suggestive. For this reason in patients in good clinical conditions, with multifocal localization and very consistent radiological findings bone biopsy could be avoided. Non-Steroidal Anti-Inflammatory Drugs are the first-choice treatment. Corticosteroids, methotrexate, bisphosphonates, TNFα-inhibitors and IL-1 blockers have also been used with some benefit; but the choice of the second line treatment depends on bone lesions localizations, presence of systemic features and patients' clinical conditions.
CONCLUSION
CNO may be difficult to identify and no consensus exist on diagnosis and treatment. Multifocal bone lesions with characteristic radiological findings are very suggestive of CNO. No data exist on best treatment option after Non-Steroidal Anti-Inflammatory Drugs failure.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Child; Diagnosis, Differential; Diphosphonates; Humans; Immunosuppressive Agents; Osteomyelitis
PubMed: 29287595
DOI: 10.1186/s12969-017-0216-7 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Nov 2021Post-traumatic osteomyelitis is one of the most common disorders of bone infection, which is secondary to open fracture caused by machinery injury, traffic accident, and...
Post-traumatic osteomyelitis is one of the most common disorders of bone infection, which is secondary to open fracture caused by machinery injury, traffic accident, and it is also the main manifestation in the postoperative infection of open fracture. After trauma, bacteria invade bone tissue and reproduce rapidly in large quantities, which easily leads to osteomyelitis. Patients are often complaint of pain at the affected limb, loss of function, or even amputation due to deteriorated infection, resulting in loss of labor capability and poor quality of life. Because the diagnosis and treatment are not timely and standard, the treatment for post-traumatic osteomyelitis is often delayed, resulting in the difficulty of clinical cure. It also makes patients and their families bear a serious financial burden. However, the diagnosis and treatment for this disease is difficult for orthopedic physicians. In recent years, imaging methods (such as CT and MRI) combined with immune techniques have significantly improved the diagnostic accuracy and early diagnosis ability. The application of new diagnostic technologies (such as gene chip and second-generation sequencing) also makes the diagnosis more convenient and sensitive. The novel reconstruction and repair surgery (such as Ilizarov technology and Orthofix LRS technology) provides new treatment direction for orthopedic surgeons and patients.
Topics: Humans; Ilizarov Technique; Osteomyelitis; Quality of Life; Treatment Outcome
PubMed: 34911865
DOI: 10.11817/j.issn.1672-7347.2021.200621 -
American Family Physician Oct 2021
Topics: Adult; Anti-Bacterial Agents; Child; Humans; Osteomyelitis
PubMed: 34652124
DOI: No ID Found -
Hand (New York, N.Y.) Sep 2023The diagnosis of hand osteomyelitis requires correlation of clinical, radiological, and microbiological findings. The role of serum inflammatory markers in diagnosing...
BACKGROUND
The diagnosis of hand osteomyelitis requires correlation of clinical, radiological, and microbiological findings. The role of serum inflammatory markers in diagnosing and prognosticating hand osteomyelitis remains uncertain. We sought to determine the utility of inflammatory markers in the diagnosis and follow-up of hand osteomyelitis, and their ability to predict outcomes, particularly amputation.
METHODS
We retrospectively reviewed 146 patients diagnosed with hand osteomyelitis and with serum inflammatory marker levels measured after the onset of symptoms and within 14 days either side of diagnosis. Blood results at first presentation including white cell count (WCC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP) were reviewed, and associations with amputations assessed. Follow-up markers taken at 15 to 60 days from diagnosis were analyzed where available.
RESULTS
Mean WCC and CRP at diagnosis were 9.2 (SD: 4.6) and 30.2 (SD: 42.4) respectively, compared with 8.2 (SD: 3.9) and 30.2 (SD: 42.4) at follow-up. At diagnosis, sensitivity of CRP was 74%, and WCC was 31%. Each marker had a low positive predictive value for amputation at diagnosis (<29%). A rise in CRP between diagnosis and follow-up was associated with an increased risk of amputation compared with a fall in CRP. The finding that WCC and CRP were both normal at diagnosis had a high negative predictive value against amputation (96%).
CONCLUSION
C-reactive protein has a higher sensitivity than WCC, NLR, and PLR when used as a diagnostic adjunct in hand osteomyelitis. White cell count and CRP both within reference ranges at diagnosis was highly negatively predictive against amputation.
Topics: Humans; Retrospective Studies; C-Reactive Protein; Biomarkers; Leukocyte Count; Osteomyelitis
PubMed: 35130740
DOI: 10.1177/15589447211066346