DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20202680

Extremity chronic osteomyelitis in a population of North East India: epidemiology, clinical characteristics and management

Tashi G. Khonglah, Bhaskar Borgohain, Wanlamkupar Khongwir, Kashif A. Ahmed

Abstract


Background: The purpose of this study was to review the epidemiology, clinical features and the management of extremity chronic osteomyelitis in a population of North East India and to provide evidenced based guidelines for early diagnosis and treatment.

Methods: We retrospectively reviewed patients who were diagnosed and treated for extremity chronic osteomyelitis at a tertiary care hospital at Shillong in North East India. Medical records for all patients were analysed and details on gender, age at incidence, anatomical site, infecting organisms, levels of inflammatory markers, and the various treatment modalities were evaluated.

Results: A total of 131 patients (96 males and 35 females) were included in this study. The median age at first diagnosis was 17 years for all. Infections caused by hematogenous osteomyelitis was found to be slightly more than those of traumatic origin. All patients had single site infections with a majority of lesions affecting the lower extremities. The tibia was the most common site in traumatic osteomyelitis while the femur was mostly involved in hematogenous osteomyelitis. The positive rate for all cultures was at 57.25% with the most commonly encountered organism being Staphylococcus aureus. Treatment methods used in our study included radical debridement with the use of local and systemic antibiotics and reconstruction of bony or soft tissue defects. The overall infection control rate was 96.18%.

Conclusions: The findings from this study can provide information for early diagnosis and treatment of this form of bone infection particularly in this part of the country. 


Keywords


Extremity chronic osteomyelitis, Bone infection, North East India, Regional characteristics

Full Text:

PDF

References


Schultz M. Microscopic investigation in fossil hominoidea: a clue to taxonomy, functional anatomy, and the history of diseases. Anat Rec. 1999;257(6):225-32.

Schmitt SK. Osteomyelitis. Infect Dis Clin North Am. 2017;31(2):325-38.

Parsons B, Strauss E. Surgical management of chronic osteomyelitis. Am J Surg. 2004;188(1):57-66.

Lew DP, Waldvogel FA. Osteomyelitis. Lancet Lond Engl. 2004;364(9431):369-79.

Mader JT, Mohan D, Calhoun J. A practical guide to the diagnosis and management of bone and joint infections. Drugs. 1997;54(2):253-64.

Mader JT, Ortiz M, Calhoun JH. Update on the diagnosis and management of osteomyelitis. Clin Podiatr Med Surg. 1996;13(4):701-24.

Museru LM, Mcharo CN. Chronic osteomyelitis: a continuing orthopaedic challenge in developing countries. Int Orthop. 2001;25(2):127-31.

Walter G, Kemmerer M, Kappler C, Hoffmann R. Treatment Algorithms for Chronic Osteomyelitis. Dtsch Arztebl Int. 2012;109(14):257-64.

Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350(14):1422-9.

Tice AD, Hoaglund PA, Shoultz DA. Outcomes of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy. Am J Med. 2003;114(9):723-8.

Gasch O, Ayats J, Dominguez AM, Tubau F, Linares J, Pena C, et al. Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection: secular trends over 19 years at a university hospital. Medicine (Baltimore). 2011;90(5):319-27.

Lye DC, Earnest A, Ling ML, Lee TE, Yong HC, Fisher DA, et al. The impact of multidrug resistance in healthcare-associated and nosocomial Gram-negative bacteraemia on mortality and length of stay: cohort study. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2012;18(5):502-8.

Perez PL, Tanoira PR, Saiz PE, Jorge PC, Rodriguez LC, Alvarez AB, et al. Osteomyelitis: A Descriptive Study. Clin Orthop Surg. 2014;6(1):20-5.

Wang X, Yu S, Sun D, Fu J, Wang S, Huang K, et al. Current data on extremities chronic osteomyelitis in southwest China: epidemiology, microbiology and therapeutic consequences. Sci Rep. 2017;7.

Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury. 2006;37(2):59-66.

Kremers HM, Nwojo ME, Ransom JE, Wentz WCM, Melton LJ, Huddleston PM. Trends in the Epidemiology of Osteomyelitis. J Bone Joint Surg Am. 2015;97(10):837-45.

Jiang N, Ma YF, Jiang Y, Zhao XQ, Xie GP, Hu YJ, et al. Clinical Characteristics and Treatment of Extremity Chronic Osteomyelitis in Southern China: A Retrospective Analysis of 394 Consecutive Patients. Medicine (Baltimore). 2015;94(42):1874.

Zimmerli W. Clinical presentation and treatment of orthopaedic implant-associated infection. J Intern Med. 2014;276(2):111-9.

Arias AC, Betancur TMC, Pinzon MA, Cardona Arango D, Taffur CCA, Prada CE. Differences in the Clinical Outcome of Osteomyelitis by Treating Specialty: Orthopedics or Infectology. PLoS ONE. 2015;10(12).

Stucken C, Olszewski DC, Creevy WR, Murakami AM, Tornetta P. Pre-operative diagnosis of infection in patients with nonunions. J Bone Joint Surg Am. 2013;95(15):1409-12.

Spellberg B, Lipsky BA. Systemic Antibiotic Therapy for Chronic Osteomyelitis in Adults. Clin Infect Dis Off Publ Infect Dis Soc Am. 2012;54(3):393-407.

Tone A, Nguyen S, Devemy F, Topolinski H, Valette M, Cazaubiel M, et al. Six-week versus twelve-week antibiotic therapy for non-surgically treated diabetic foot osteomyelitis: a multicenter open-label controlled randomized study. Diabetes Care. 2015;38(2):302-7.

Conterno LO, Turchi MD. Antibiotics for treating chronic osteomyelitis in adults. Cochrane Database Syst Rev. 2013;9:CD004439.