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The Surgeon : Journal of the Royal... Aug 2021Orthoplastic operations for lower limb osteomyelitis (LLOM) involving microvascular free tissue reconstructions ("free-flaps") are usually performed under general...
Patients' reported experiences and outcomes following surgical excision of lower limb osteomyelitis and microvascular free tissue reconstruction under 'awake' epidural anaesthesia and sedation.
BACKGROUND
Orthoplastic operations for lower limb osteomyelitis (LLOM) involving microvascular free tissue reconstructions ("free-flaps") are usually performed under general anaesthesia (GA), with or without epidural anaesthesia (EA) due to concerns about the discomfort associated with prolonged surgery. However, our clinical experience supports "awake" epidural anaesthesia with sedation (EA + Sed) rather than EA + GA as a technique of choice for this type of surgery.
METHODS
We used a standardised postoperative questionnaire to formally assess the experiences and outcomes for 50 patients who underwent free-flaps for LLOM under EA + Sed.
FINDINGS
The mean duration of surgery was 522 min (8.7 h), range 240-875 min. There were no ITU admissions or flap failures. Postoperatively, fifty patients completed a standardised questionnaire about their experiences before the operation, in the anaesthetic room and theatre. 80% were aware of the procedure at least "some of the time". 72.5% patients and 75% respectively, did not have any concerns in the anaesthetic room and theatre. Concerns expressed by the remaining patients were manageable. 97.5% of those patients who recalled their operation reported their overall experience as "comfortable" or "very comfortable". 92% of respondents had undergone previous lower limb surgery under GA ± EA. In this subgroup, 91.3% reported the recovery after EA + Sed as "quicker" than GA, and 89.4% reported their experience with EA + Sed as "better". All fifty patients (100%) were "satisfied" or "very satisfied" with their experience and all but one (98%) would recommend this technique to others.
CONCLUSIONS
Our study showed that despite prolonged duration, the patients' reported experiences and outcomes were excellent when EA + Sed was used for orthoplastic operations involving free-flaps for LLOM. We recommend EA + Sed as the anaesthetic technique of choice for such patients.
Topics: Anesthesia, Epidural; Anesthesia, General; Humans; Lower Extremity; Osteomyelitis; Wakefulness
PubMed: 32616367
DOI: 10.1016/j.surge.2020.05.001 -
Practical Neurology Feb 2023
Topics: Humans; Osteomyelitis; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Recurrence
PubMed: 36717208
DOI: 10.1136/pn-2022-003522 -
The Permanente Journal May 2021Use of daptomycin at doses ≥ 6 mg/kg for treatment of osteomyelitis is increasing in clinical practice; unfortunately, limited data are available to guide optimal...
BACKGROUND
Use of daptomycin at doses ≥ 6 mg/kg for treatment of osteomyelitis is increasing in clinical practice; unfortunately, limited data are available to guide optimal dosing and duration. The objective of this study was to assess daptomycin dosing and duration regimens for osteomyelitis treatment.
METHODS
This was a retrospective, multi-site, cohort study conducted in an integrated healthcare delivery system. Nonpregnant patients ≥ 18 years of age with osteomyelitis diagnosed between November 1, 2003 and June 30, 2011, ≥ 2 weeks outpatient daptomycin therapy, and ≥ 1 month of follow-up were included. Daptomycin doses < 6 mg/kg and ≥ 6 mg/kg at durations of < 6 weeks and ≥ 6 weeks were examined with univariate and multivariate analyses to assess treatment success and all-cause mortality.
RESULTS
A total of 247 patients were included, with 39 (15.8%), 37 (15.0%), 107 (43.3%), and 64 (25.9%) receiving < 6 mg/kg and ≥ 6 weeks, < 6 mg/kg and < 6 weeks, ≥ 6 mg/kg and ≥ 6 weeks, and ≥ 6 mg/kg and < 6 weeks of daptomycin therapy, respectively. Patients had a mean age of 58 years and had received prior vancomycin therapy (65.6%). Patients receiving < 6 weeks of therapy were less likely to experience treatment success compared with ≥ 6 weeks (41.5% vs 25.3%, adjusted odds ratio = 0.55; 95% confidence interval = 0.31-0.98) independent of duration. There were no differences across groups in mortality after adjustment.
CONCLUSION
In a diverse clinical population, daptomycin for treatment of osteomyelitis of 6 weeks or longer duration was associated with success independent of dose. This finding supports longer treatment with daptomycin as a first-line agent in antimicrobial stewardship initiatives.
Topics: Anti-Bacterial Agents; Cohort Studies; Daptomycin; Humans; Middle Aged; Osteomyelitis; Outpatients; Retrospective Studies; Treatment Outcome
PubMed: 35348074
DOI: 10.7812/TPP/20.297 -
Wounds : a Compendium of Clinical... Aug 2019The aim of this meta-analysis is to evaluate the effect of withholding antibiotics prior to obtaining a bone biopsy in the diagnosis of osteomyelitis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this meta-analysis is to evaluate the effect of withholding antibiotics prior to obtaining a bone biopsy in the diagnosis of osteomyelitis.
METHODS
Literature searches on Scopus, PubMed, and Google Scholar were performed with the input antibiotic, bone, biopsy, osteomyelitis, and prior both separately and together, though initially as a combination, as key words for all study types in the English language published up until July 2018. The initial combination search (and subsequent additional search of the references) yielded 924 related articles, which ultimately resulted in 12 articles with adequate data for analysis. Data were analyzed using an inverse variance method to determine the weight of the studies in a random effects model, pooling the data for odds ratios (OR) and heterogeneity. Bias risk was determined with the Quality Assessment of Diagnostic Accuracy Studies 2 system.
RESULTS
Of the 12 studies, 8 failed to demonstrate that antibiotics administered prior to bone biopsy have an effect on culture yield, while 4 reported a significant effect on culture yield. The total weighted OR for all studies was 2.02 (95% confidence interval [CI], 0.94-4.36; P = .04) and the prediction interval was 0.17-23.63. When vertebral osteomyelitis (VO) and nonvertebral osteomyelitis (NVO) articles were evaluated separately, the VO OR was 2.95 (95% CI, 1.40-6.24) and the prediction interval was 0.40-21.53. The OR for NVO was 0.66 (95% CI, 0.04-12.03) and the prediction interval was 0-114.53.
CONCLUSIONS
When all studies as well as when NVO studies only were evaluated, there was no significant difference in bacterial pathogen yield based on antibiotic exposure. When VO studies were evaluated separately, there were fewer pathogens recovered than when antibiotics were administered prior to obtaining bone cultures.
Topics: Anti-Bacterial Agents; Bacterial Load; Bacteriological Techniques; Biopsy, Fine-Needle; Bone and Bones; Drug Substitution; Humans; Osteomyelitis
PubMed: 31356178
DOI: No ID Found -
Scientific Reports Apr 2023Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disorder. The origin and development of CNO involve many complex immune processes, resulting in...
Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disorder. The origin and development of CNO involve many complex immune processes, resulting in delayed diagnosis and a lack of effective treatment. Although bioinformatics analysis has been utilized to seek key genes and pathways in CNO, only a few bioinformatics studies that focus on CNO pathogenesis and mechanisms have been reported. This study aimed to identify key biomarkers that could serve as early diagnostic or therapeutic markers for CNO. Two RNA-seq datasets (GSE133378 and GSE187429) were obtained from the Gene Expression Omnibus (GEO). Weighted gene coexpression network analysis (WGCNA) and differentially expressed gene (DEG) analysis were conducted to identify the genes associated with CNO. Then, the autoinflammatory genes most associated with CNO were identified based on the GeneCards database and a CNO prediction model, which was created by the LASSO machine learning algorithm. The accuracy of the model and effects of the autoinflammatory genes according to receiver operating characteristic (ROC) curves were verified in external datasets (GSE7014). Finally, we performed clustering analysis with ConsensusClusterPlus. In total, eighty CNO-related genes were identified and were significantly enriched in the biological processes regulation of actin filament organization, cell-cell junction organization and gamma-catenin binding. The main enriched pathways were adherens junctions, viral carcinogenesis and systemic lupus erythematosus. Two autoinflammatory genes with high expression in CNO samples were identified by combining an optimal machine learning algorithm (LASSO) with the GeneCards database. An external validation dataset (GSE187429) was utilized for ROC analysis of the prediction model and two genes, and the results indicated good efficiency. Then, based on consensus clustering analysis, we found that the expression of UTS2 and MPO differed between clusters. Finally, the ceRNA network of lncRNAs and the small molecule compounds targeting the two autoinflammatory genes were predicted. The identification of two autoinflammatory genes, the HCG18/has-mir-147a/UTS2/MPO axis and signalling pathways in this study can help us understand the molecular mechanism of CNO formation and provides candidate targets for the diagnosis and treatment of CNO.
Topics: Humans; Gene Expression Profiling; RNA-Seq; Machine Learning; Osteomyelitis
PubMed: 37085667
DOI: 10.1038/s41598-023-33759-y -
Journal of Veterinary Internal Medicine 2024Vertebral infections, including vertebral osteomyelitis, septic physitis, and discospondylitis, are rarely reported in goats, and when reported, have been largely...
BACKGROUND
Vertebral infections, including vertebral osteomyelitis, septic physitis, and discospondylitis, are rarely reported in goats, and when reported, have been largely limited to necropsy case reports.
OBJECTIVE
Describe clinical findings and outcome in goats with vertebral infections evaluated by computed tomography (CT).
ANIMALS
Five goats with vertebral osteomyelitis, septic physitis, and discospondylitis evaluated by CT.
METHODS
Retrospective case series.
RESULTS
The most common presenting complaints were progressive weakness, paresis and recumbency. Three goats were tetraparetic and 2 goats had pelvic limb paraparesis. Clinicopathologic findings included leukocytosis, mature neutrophilia, and hyperfibrinogenemia. The most common vertebrae affected were C7-T1. All 5 goats had discospondylitis with or without vertebral osteomyelitis and septic physitis. Computed tomographic evidence of spinal cord compression was present in 4/5 goats. Medical management (antimicrobials, physical therapy, analgesia, supportive care) was attempted in 4 goats, and 1 goat was euthanized at the time of diagnosis. All 4 goats that were treated regained ambulatory ability and survived to hospital discharge.
CONCLUSIONS AND CLINICAL IMPORTANCE
Despite severity of CT imaging findings, goats with discospondylitis, septic physitis, and vertebral osteomyelitis can successfully return to ambulatory function. Additional studies are required to determine ideal treatment regimens.
Topics: Animals; Goats; Goat Diseases; Osteomyelitis; Retrospective Studies; Female; Tomography, X-Ray Computed; Male; Discitis; Spondylitis; Spinal Diseases
PubMed: 38483064
DOI: 10.1111/jvim.17035 -
Journal of Microbiology, Immunology,... Oct 2022The insidious nature of BCG-osteomyelitis makes it challenging for clinicians to detect it early on.
BACKGROUND
The insidious nature of BCG-osteomyelitis makes it challenging for clinicians to detect it early on.
METHODS
This 12-year retrospective analysis was conducted at a single tertiary hospital in central Taiwan. Electronic medical records of pediatric patients treated for BCG-osteomyelitis were reviewed. Demographics, clinical features, and laboratory findings were compared with patients diagnosed with culture-proven pyogenic osteomyelitis.
RESULTS
In total, eight patients fulfilled our inclusion criteria. Their median age was 16 months, and no obvious gender prevalence was found. Six of the eight patients had lesions involving the lower extremities. When compared with the pyogenic osteomyelitis group, age of disease onset was found to be significantly younger in the BCG osteomyelitis group (p=0.038). Absence of fever and pain in the BCG osteomyelitis group was found to be statistically significant when compared with the pyogenic group (p=0.002 and p=0.026 respectively). CRP and ESR were found to be significantly higher in the pyogenic osteomyelitis group (p=0.000 and p=0.004 respectively).
CONCLUSION
BCG-related osteomyelitis must be considered when evaluating an afebrile child presenting with an unexplainable swelling or limp, and especially when the lesion is located on a lower limb. Laboratory studies may reveal normal WBC and CRP, with a normal to modest elevation of ESR. Imaging studies, including plain radiographs, magnetic resonance imaging (MRI), or computed tomography (CT) should be employed to rule out BCG-related osteomyelitis. Early diagnosis help minimize inappropriate antibiotics use, and may lead to a better outcome.
Topics: Humans; Child; Infant; BCG Vaccine; Retrospective Studies; Taiwan; Osteomyelitis; Mycobacterium bovis; Anti-Bacterial Agents
PubMed: 34696993
DOI: 10.1016/j.jmii.2021.09.007 -
BMC Veterinary Research Jun 2023In dogs, the most frequently reported mycosis associated with Aspergillus spp. are respiratory infections. Systemic aspergillosis is uncommon, with reported cases been...
BACKGROUND
In dogs, the most frequently reported mycosis associated with Aspergillus spp. are respiratory infections. Systemic aspergillosis is uncommon, with reported cases been associated with several Aspergillus species. Aspergillus terreus species complex are ubiquitous organisms, unfrequently associated with local or systemic disease in animals and humans, and treatment of osteomyelitis caused by this species is usually unfavorable.
CASE PRESENTATION
This case report describes the case of a 5-year-old dog, referred to the Veterinary Hospital of the Faculty of Veterinary Medicine of the University of Lisbon, Portugal, with a history of lameness of the right thoracic limb. Radiographs and CT scan revealed two different lesions on right humerus and radio, which were biopsied. The samples collected were submitted to cytological and histopathological evaluation and bacterial and mycological culture. Environmental samples, including of the surgery room and of the biopsy needle were also evaluated for the presence of fungi. Regarding biopsy samples, bacterial culture was negative, but mycological analysis originated a pure culture of a fungal species later identified as Aspergillus terreus by Sanger sequencing. Results were compatible with histopathologic examination, which revealed periosteal reaction and invasion of hyphae elements. Also, mycological analysis of both environmental samples evaluated were negative. The virulence profile of the fungal isolate was phenotypically characterized using specific media, allowing to reveal its ability to produce several enzymes involved in its pathogenicity, namely lipase, hemolysin and DNAse, corresponding to a Virulence Index (V. Index.) of 0.43. The patient was submitted to itraconazole therapy for 8 weeks. After 3 weeks, the patient showed significant clinical improvement, and after 6 weeks no radiographic signs were observed.
CONCLUSIONS
Antifungal therapy with itraconazole can contribute to the remission of canine infections promoted by Aspergillus terreus complex with a relevant V. Index.
Topics: Humans; Dogs; Animals; Antifungal Agents; Itraconazole; Aspergillus; Osteomyelitis; Dog Diseases
PubMed: 37291542
DOI: 10.1186/s12917-023-03628-x -
Journal of Pediatric Orthopedics. Part B Sep 2023The purpose of this study was to evaluate the sensitivity, specificity, and predictive value of serum procalcitonin (PCT) for osteomyelitis and septic arthritis in... (Meta-Analysis)
Meta-Analysis
The purpose of this study was to evaluate the sensitivity, specificity, and predictive value of serum procalcitonin (PCT) for osteomyelitis and septic arthritis in children. PubMed, EMBase, and Cochrane Library were searched until 10 August 2021, for eligible literature focusing on PCT for the diagnosis of osteomyelitis and septic arthritis. Four articles with six studies were included in the diagnostic meta-analysis, a total of 654 children were examined for bacterial cultures in PCT, osteomyelitis, and septic arthritis. The results of diagnostic meta-analysis showed that the PCT had a sensitivity of 0.72, 95% confidence interval (CI) (0.65-0.79), specificity of 0.90, 95% CI (0.87-0.93), positive likelihood ratio (LR) of 3.87, 95% CI (2.53-5.90), negative LR of 0.39, 95% CI (0.22-0.70), and diagnostic odds ratio was 13.13, 95% CI (6.46-26.66), for the detection of osteomyelitis and septic arthritis using bacterial culture as the gold standard. Based on the summary receiver operating characteristic curve of PCT, it was found that the area under the curve of PCT was 0.88. In the evaluation of publication bias, the result of the regression line test showed that there was not publication bias (bias = 13.72; 95% CI, -1.84 to 29.28; P = 0.07). This study provided systematic review of the published literature on the diagnosis of osteomyelitis and septic arthritis in children using PCT, which may serve as a biomarker for diagnosis of osteomyelitis, but it has no direct evidences to support the diagnosis of septic arthritis. However, the specific optimal cutoff value of PCT and specific population still needed to be verified by large sample studies.
Topics: Child; Humans; Procalcitonin; Calcitonin; Calcitonin Gene-Related Peptide; Protein Precursors; Osteomyelitis; ROC Curve; Arthritis, Infectious; Diagnostic Tests, Routine
PubMed: 36421016
DOI: 10.1097/BPB.0000000000001041 -
Journal of Orthopaedic Research :... Feb 2021Chronic osteomyelitis has always been a therapeutic challenge for patient and surgeon due to the specific problems related with bone infection and bacterial biofilm... (Review)
Review
Chronic osteomyelitis has always been a therapeutic challenge for patient and surgeon due to the specific problems related with bone infection and bacterial biofilm eradication. Other than being the cause of infection or facilitating spread or persistence of infection, biomaterials are also becoming a tool in the treatment of infection. Certain novel biomaterials have unique and ideal properties that render them perfectly suited to combat infection and are therefore used more and more in the treatment of chronic bone infections. In case of infection treatment, there is still debate whether these properties should be focused on bone regeneration and/or their antimicrobial properties. These properties will be of even greater importance with the challenge of emerging antimicrobial resistance. This review highlights indications for use and specific material properties of some commonly used contemporary biomaterials for this indication as well as clinical experience and a literature overview.
Topics: Anti-Bacterial Agents; Biocompatible Materials; Bone Regeneration; Chronic Disease; Debridement; Humans; Osteomyelitis; Tissue Scaffolds
PubMed: 33098587
DOI: 10.1002/jor.24896