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Wound Management & Prevention May 2021Osteomyelitis of the foot is a risk factor for amputation in persons with diabetes mellitus. There is some evidence to suggest that patient sex affects the risk of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Osteomyelitis of the foot is a risk factor for amputation in persons with diabetes mellitus. There is some evidence to suggest that patient sex affects the risk of diabetes-related foot complications.
PURPOSE
To examine the effect of sex on osteomyelitis risk in patients with diabetic foot disease.
METHODS
Systematic searches of PubMed and the China National Knowledge Infrastructure were performed from inception through May 2020 using the terms "diabetic foot" and "osteomyelitis." Original research studies including persons with diabetes mellitus, diabetic foot disease, or ulcers as well as reports of osteomyelitis were included. Study quality was assessed according to the Newcastle-Ottawa Scale. The pooled odds ratio (OR) and 95% confidence interval (CI) for osteomyelitis were calculated by sex.
RESULTS
Nine (9) studies from 6 countries involving 2583 patients met the inclusion criteria for analysis. No significant publication bias was observed. The average age of patients was 65.2 years, and 32.03% of men and 30.0% of women were diagnosed with osteomyelitis. The pooled OR was 1.14 (95% CI, 0.94-1.38; P = .76). Regression analysis (t = -0.61; P > .561) showed no association between the incidence of osteomyelitis and ORs.
CONCLUSION
This meta-analysis suggests that patient sex does not affect the odds of having osteomyelitis among persons with diabetes and diabetic foot disease or ulcers.
Topics: Aged; Amputation, Surgical; Diabetes Mellitus; Diabetic Foot; Female; Humans; Lower Extremity; Male; Osteomyelitis; Sex Characteristics
PubMed: 34283801
DOI: No ID Found -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... May 2020To review the progress of clinical diagnosis and treatment of chronic osteomyelitis in adults. (Review)
Review
OBJECTIVE
To review the progress of clinical diagnosis and treatment of chronic osteomyelitis in adults.
METHODS
The literature related to chronic osteomyelitis in recent years was extensively reviewed, and the clinical diagnosis and treatment methods were summarized.
RESULTS
Clinical characteristics and laboratory examination can help to diagnose chronic osteomyelitis in adults. Pathogenic identification is the basis for choosing antibiotics. Diagnostic imaging is specific. The treatment includes systemic treatment and local treatment, and the local treatment is the key to radical cure.
CONCLUSION
The diagnosis of chronic osteomyelitis in adults should be made as early as possible. According to the anatomical and physiological classification of the patients, the appropriate treatment plan should be made.
Topics: Adult; Anti-Bacterial Agents; Chronic Disease; Humans; Osteomyelitis
PubMed: 32410435
DOI: 10.7507/1002-1892.201909032 -
Pediatric Blood & Cancer Oct 2020Children with sickle cell disease (SCD) are at increased risk for bacterial infections including osteomyelitis (OM). Fever and bone pain, key presenting symptoms of OM,...
BACKGROUND
Children with sickle cell disease (SCD) are at increased risk for bacterial infections including osteomyelitis (OM). Fever and bone pain, key presenting symptoms of OM, are common in SCD, thus complicating diagnosis. We reviewed presentation, imaging features, and microbiologic etiologies of children with SCD treated for OM.
METHODS
The comprehensive SCD clinical database of children and adolescents with SCD followed at a single, large tertiary pediatric center were searched to identify all diagnostic coding for potential cases of osteomyelitis in children ages 6 months to 21 years from 2010 to 2019. Medical charts were reviewed to determine OM diagnostic probability based on radiographic and microbiologic findings and the duration of prescribed antibiotic treatment for OM.
RESULTS
Review of 3553 patients (18 039 person-years) identified 20 episodes of probable OM in 19 children. Magnetic resonance imaging (MRI) findings to support OM were definitive in 4/19 (21%), probable in 10/19 (53%), suspected in 5/19 (26%), based on blinded radiologist review. Blood and/or operative cultures from bone and tissue debridement isolated Salmonella species in seven (35%) cases and methicillin-susceptible Staphylococcus aureus (MSSA) in two (10%). Six patients received antibiotic treatment prior to obtainment of cultures. Of culture-positive cases, MRI findings for OM were definitive or probable in six of nine (67%), suspected in three of nine (33%).
CONCLUSIONS
Distinction between OM and sickle-related bone infarct or vasoocclusion is difficult based on imaging findings alone. Early attainment of blood and operative cultures increases the likelihood of identifying and adequately treating OM.
Topics: Adolescent; Adult; Anemia, Sickle Cell; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Osteomyelitis; Prognosis; Retrospective Studies; Salmonella; Salmonella Infections; Young Adult
PubMed: 32710705
DOI: 10.1002/pbc.28517 -
BMJ Open Diabetes Research & Care Dec 2023Osteomyelitis is associated with significant morbidity, including amputation. There are limited data on long-term amputation rates following an osteomyelitis diagnosis.... (Observational Study)
Observational Study
INTRODUCTION
Osteomyelitis is associated with significant morbidity, including amputation. There are limited data on long-term amputation rates following an osteomyelitis diagnosis. We sought to determine the incidence of amputation in patients with osteomyelitis over 2 years.
RESEARCH DESIGN AND METHODS
Observational cohort study of 1186 inpatients with osteomyelitis between 2004 and 2015 and stratified by osteomyelitis location status to evaluate the impact on amputation, mortality rates, readmission data, and inpatient days.
RESULTS
Persons with diabetes had 3.65 times greater probability of lower extremity amputation (p<0.001), readmission (p<0.001), and longer inpatient stay (p<0.001) and had higher 2-year mortality (relative risk (RR) 1.23, p=0.0027), adjusting for risk factors. Male gender (RR 1.57, p<0.001), black race (RR 1.41, p<0.05), former smoking status (RR 1.38, p<0.01), myocardial infarction (RR 1.72, p<0.001), congestive heart failure (RR 1.56, p<0.001), peripheral vascular disease (RR 2.25, p<0.001) and renal disease (RR 1.756, p<0.001) were independently associated with amputation. Male gender (RR 1.39, p<0.01), black race (RR 1.27, p<0.05), diabetes (RR 2.77, p<0.001) and peripheral vascular disease (RR 1.59, p<0.001) had increased risk of lower, not upper, extremity amputation.
CONCLUSIONS
Patients with osteomyelitis have higher rates of amputation and hospitalization. Clinicians must incorporate demographic and comorbid risk factors to protect against amputation.
Topics: Humans; Male; Amputation, Surgical; Diabetic Foot; Extremities; Incidence; Osteomyelitis; Peripheral Vascular Diseases; Female
PubMed: 38164707
DOI: 10.1136/bmjdrc-2023-003611 -
MedEdPORTAL : the Journal of Teaching... 2023Biases in communication can be harmful to patient perceptions of care and the medical team's decision-making. Optimal communication must be taught and practiced... (Review)
Review
INTRODUCTION
Biases in communication can be harmful to patient perceptions of care and the medical team's decision-making. Optimal communication must be taught and practiced similarly to the optimal management of the complex medical conditions associated with sickle cell disease (SCD). This simulation is designed to teach about biases, optimizing communication to and about a patient with SCD, and appropriately diagnosing and managing pediatric osteomyelitis as a complication of SCD.
METHODS
We designed and implemented a simulation case targeting emergency medicine residents and fellows to raise awareness about biases associated with SCD care and the complication of osteomyelitis in children with SCD. The case was delivered as a scheduled educational activity. Guided debriefing about optimizing care and communication for this patient population followed the simulation. We measured outcomes based on facilitator field notes and participant evaluations (Likert-scale and open-response questions).
RESULTS
Forty learners of varying medical practice proficiencies, societal experiences, and demographics participated, with 30 completing the postsimulation feedback survey. A majority (97%) of participants indicated that the experience was useful and would improve their clinical performance. Participants learned from each other's language and communication styles and reflected on their own communication.
DISCUSSION
Overall, participants found the simulation very useful as a review of the medical diagnosis and management of osteomyelitis in pediatric SCD. Moreover, they were very engaged and interested in the opportunity to learn about communication biases, particularly as these relate to SCD, to optimize their patient care.
Topics: Humans; Child; Communication; Language; Pain; Anemia, Sickle Cell; Osteomyelitis
PubMed: 37593566
DOI: 10.15766/mep_2374-8265.11335 -
Medical Mycology Oct 2017Osteomyelitis and arthritis caused by mucormycetes are rare diseases that rank among the most challenging complications in orthopedic and trauma surgery. The aim of this... (Review)
Review
Osteomyelitis and arthritis caused by mucormycetes are rare diseases that rank among the most challenging complications in orthopedic and trauma surgery. The aim of this work is to review the epidemiological, clinical, diagnostic, and therapeutic aspects of the osteoarticular mucormycosis with particular emphasis on high-risk patients. A systematic review of osteoarticular mucormycosis was performed using PUBMED and EMBASE databases from 1978 to 2014. Among 34 patients with median age 41 (0.5-73 years), 24 (71%) were males. While 12 (35%) were immunocompromised patients, 14 (41%) had prior surgery, and seven (21%) suffered trauma. Other underlying conditions included diabetes mellitus, hematological malignancies, transplantation, and corticosteroid therapy. The median diagnostic delay from onset of symptoms and signs was 60 (10-180) days. The principal mechanism of the infection was direct inoculation (n = 19; 56%), and in immunocompromised patients was usually hematogenous disseminated. The long bones were infected by trauma or surgery, while a wide variety of bones were involved by hematogenous dissemination. Combined surgery and amphotericin B treatment were implemented in 28 (82%) and eight (23%) had an unfavorable outcome. Osteoarticular mucormycosis occurs most frequently after trauma or surgical procedures. These infections are progressively destructive and more virulent in individuals with impaired immune systems. Early diagnosis, timely administration of amphotericin B, control of underlying conditions, and surgical debridement of infected tissue are critical for successful management of osteoarticular mucormycosis.
Topics: Adolescent; Adult; Aged; Antifungal Agents; Arthritis; Child; Child, Preschool; Debridement; Early Diagnosis; Female; Humans; Infant; Male; Middle Aged; Mucorales; Mucormycosis; Osteomyelitis; Surgical Wound Infection; Wounds and Injuries; Young Adult
PubMed: 28053147
DOI: 10.1093/mmy/myw136 -
Infection Dec 2021The incidence of bone and joint infections is increasing while their treatment remains a challenge. Although guidelines and recommendations exist, evidence is often...
PURPOSE
The incidence of bone and joint infections is increasing while their treatment remains a challenge. Although guidelines and recommendations exist, evidence is often lacking and treatment complicated by complex clinical presentations and therapeutic options. Interdisciplinary boards shown to improve management of other diseases, seem potentially helpful. We describe the establishment of an osteomyelitis board to show the existing demand for such a platform.
METHODS
All patients discussed in the board for bone and joint infections between October 2014 and September 2020 were included in this retrospective study. Data were extracted from patient records and analyzed descriptively.
RESULTS
A total of 851 requests related to 563 patients were discussed in the board during the study period. After a run-in period of 3 years, a stable number of cases (> 170/year) were discussed, submitted by nearly all hospital departments (22 of 25). Recommendations were mainly related to antibiotic treatment (43%) and to diagnostics (24%). Periprosthetic joint infections were the most frequent entity (33%), followed by native vertebral osteomyelitis and other osteomyelitis. In 3% of requests, suspected infection could be excluded, in 7% further diagnostics were recommended to confirm or rule out infection.
CONCLUSIONS
A multidisciplinary board for bone and joint infections was successfully established, potentially serving as a template for further boards. Recommendations were mainly related to antibiotic treatment and further diagnostics, highlighting the need for interdisciplinary discussion to individualize and optimize treatment plans based on guidelines. Further research in needed to evaluate impact on morbidity, mortality and costs.
Topics: Anti-Bacterial Agents; Arthritis, Infectious; Humans; Osteomyelitis; Retrospective Studies
PubMed: 34339039
DOI: 10.1007/s15010-021-01676-9 -
Journal of AAPOS : the Official... Feb 2022We present the case of an 8-year-old girl with chronic recurrent multifocal osteomyelitis (CRMO) involving the orbit and facial bone and causing left optic neuropathy....
We present the case of an 8-year-old girl with chronic recurrent multifocal osteomyelitis (CRMO) involving the orbit and facial bone and causing left optic neuropathy. She presented with intermittent left periorbital swelling and a history of CRMO diagnosed 5 years earlier. Her disease responded well to adalimumab; however, delayed presentation resulted in permanent unilateral optic nerve atrophy and reduced vision. Orbital inflammatory disease is a rare manifestation of CRMO, and early recognition of the disease and treatment may prevent irreversible vision loss.
Topics: Child; Chronic Disease; Female; Humans; Optic Nerve; Optic Nerve Diseases; Osteomyelitis; Rare Diseases
PubMed: 34813967
DOI: 10.1016/j.jaapos.2021.09.003 -
The Bone & Joint Journal Feb 2015Little information is available about several important aspects of the treatment of melioidosis osteomyelitis and septic arthritis. We undertook a retrospective review...
Little information is available about several important aspects of the treatment of melioidosis osteomyelitis and septic arthritis. We undertook a retrospective review of 50 patients with these conditions in an attempt to determine the effect of location of the disease, type of surgical intervention and duration of antibiotic treatment on outcome, particularly complications and relapse. We found that there was a 27.5% risk of osteomyelitis of the adjacent bone in patients with septic arthritis in the lower limb. Patients with septic arthritis and osteomyelitis of an adjacent bone were in hospital significantly longer (p = 0.001), needed more operations (p = 0.031) and had a significantly higher rate of complications and re-presentation (p = 0.048). More than half the patients (61%), most particularly those with multifocal bone and joint involvement, and those with septic arthritis and osteomyelitis of an adjacent bone who were treated operatively, needed more visits to theatre.
Topics: Adult; Anti-Bacterial Agents; Arthritis, Infectious; Combined Modality Therapy; Comorbidity; Female; Humans; Male; Melioidosis; Middle Aged; Osteomyelitis
PubMed: 25628295
DOI: 10.1302/0301-620X.97B2.34799 -
Scientific Reports Oct 2018The differential diagnosis of Ewing sarcoma and osteomyelitis can be challenging and can lead to delays in treatment with possibly devastating results. In this...
The differential diagnosis of Ewing sarcoma and osteomyelitis can be challenging and can lead to delays in treatment with possibly devastating results. In this retrospective, small-cohort study we demonstrate, that the Fourier Transformed Infrared (FTIR) spectra of osteomyelitis bone tissue can be differentiated from Ewing sarcoma and normal bone tissue sampled outside tumour area. Significant differences in osteomyelitis samples can be seen in lipid and protein composition. Supervised learning using a quadratic discriminant analysis classifier was able to differentiate the osteomyelitis samples with high accuracy. FTIR spectroscopy, alongside routine radiological and histopathological methods, may offer an additional tool for the differential diagnosis of osteomyelitis and ES.
Topics: Adolescent; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Male; Multifactor Dimensionality Reduction; Osteomyelitis; Protein Structure, Secondary; Sarcoma, Ewing; Spectroscopy, Fourier Transform Infrared; Young Adult
PubMed: 30305666
DOI: 10.1038/s41598-018-33470-3