J Bone Jt Infect 2018; 3(1):20-26. doi:10.7150/jbji.22566
Outcomes and Risk Factors for Polymicrobial Posttraumatic Osteomyelitis
1. Hospital de Base, Infection Control Unit, São José do Rio Preto Medical School, São Paulo, Brazil.
2. Orthopedics and Traumatology Unit, São José do Rio Preto Medical School, São Paulo, Brazil.
3. Division of Infectious Diseases, Department of Internal Medicine; Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
4. Instituto Nacional de traumatologia e Ortopedia (INTO); Rio de Janeiro, Brazil.
Background: We hypothesized that polymicrobial posttraumatic osteomyelitis (PTO) may be associated with worse outcomes when compared to monomicrobial PTO. We therefore attempted to show the outcomes and predisposing factors associated with polymicrobial PTO.
Methods: A single-center case-control study was carried out from 2007 to 2012. The outcome variables analyzed were: the need for additional surgical and antibiotic treatments, rates of amputation, and mortality associated with the infection. Univariate and multivariable analyses using multiple logistic regression were performed to identify risk factors associated with polymicrobial PTO, and p < 0.05 was considered significant.
Results: Among the 193 patients identified, polymicrobial PTO was diagnosed in 37.8%, and was significantly associated with supplementary surgical debridement (56.1% vs. 31%; p < 0.01), a higher consumption of antibiotics, and more amputations (6.5% vs 1.3%; p < 0.01). Factors associated with polymicrobial PTO in the multivariable analysis were older age (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 1.01 to 1.03, p = 0.04), working in agriculture (OR = 2.86, 95% CI = 1.05 to 7.79, p = 0.04), open fracture Gustilo type III (OR = 2.38, 95% CI = 1.02 to 5.56, p = 0.04), need for blood transfusion (OR = 2.15, 95% CI = 1.07 to 4.32, p = 0.03), and need for supplementary debridement (OR = 2.58, 95% CI = 1.29 to 5.16, p = 0.01).
Conclusions: PTO is polymicrobial in more than one-third of patients, associated with extra surgical and clinical treatment, and worse outcomes including higher rates of amputation.
Keywords: Chronic osteomyelitis, polymicrobial infection, monomicrobial infection, posttraumatic osteomyelitis, risk factors, Staphylococcus aureus
Jorge LS, Fucuta PS, Oliveira MGL, Nakazone MA, de Matos JA, Chueire AG, Salles MJC. Outcomes and Risk Factors for Polymicrobial Posttraumatic Osteomyelitis. J Bone Jt Infect 2018; 3(1):20-26. doi:10.7150/jbji.22566. Available from http://www.jbji.net/v03p0020.htm