Osteomyelitis: Etiology, Diagnosis, Treatment and Outcome in a Public versus a Private Institution

Abstract

Background: Although bone infections are difficult to diagnose and manage, primary health care providers often give comprehensive care to patients with few referrals. To evaluate how trends in care impact upon management of bone infections, we performed a retrospective review of medical records of 198 osteomyelitis patients.

Patients and Methods: 130 patients were hospitalized at a private institution and 68 were hospitalized at a public (teaching) institution. Outcomes measured were bone salvage or loss in relation to predisposing co-morbidities and infectious disease (ID) physician involvement in the patient care.

Results: Co-morbidities predominating at the public and private hospitals, respectively, were presence of metal implants (20% and 37%) and diabetes (32% and 31%). The most common pathogens at the public and private hospitals, respectively, were methicillin-susceptible Staphylococcus aureus (MSSA, 16 and 32%) and methicillin-resistant S. aureus (MRSA, 3% and 31%). ID specialists treated longer with iv antibiotics (42 and 43.5 median treatment days) than non-ID specialists (14 and 7 median treatment days). When ID specialists were involved in case management, a trend to bone salvage was seen at the public hospital (p < 0.09).

Conclusion: Osteomyelitis patient outcome varies less by hospital setting than by case management.