Skip to main content

Advertisement

SpringerLink
Log in

Duration of post-surgical antibiotic therapy for adult chronic osteomyelitis: a single-centre experience

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The optimal duration of concomitant antibiotic therapy after surgical intervention for implant-free chronic osteomyelitis is unknown. No randomized data exist. Available recommendations are based on expert’s opinion. We evaluated the duration of post-surgical antibiotic treatment related to remission of chronic osteomyelitis.

Methods

This was a retrospective single-centre study at Geneva University Hospitals with a minimal follow-up of two years after treatment. We used multivariate logistic regression analysis with exclusion of pediatric cases and of implant-related chronic osteomyelitis.

Results

A total of 49 episodes of implant-free chronic osteomyelitis in 49 adult patients were studied. The median number of surgical interventions was two (range, 1–10). The median duration of post-debridement antibiotic treatment was eight weeks (range, 4–14 weeks). Thirty-nine patients (80%) were in remission after a minimal follow-up of two years. In multivariate logistic regression analysis, one week of intravenous therapy had the same remission as two to three weeks (0.2, 0.1–1.9) or ≥ 3 weeks (0.3, 0.1–2.4). More than six weeks of total antibiotic treatment equalled ≤  six weeks (0.8, 0.1–5.2).

Conclusions

In chronic osteomyelitis in adults, a post-debridement antibiotic therapy beyond six weeks, or an IV treatment longer than one week, did not show enhanced remission incidences. Prospective randomized trials are required to confirm this observation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Beals RK, Bryant RE (2005) The treatment of chronic open osteomyelitis of the tibia in adults. Clin Orthop Relat Res 433:212–217

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Panda M, Ntungila N, Kalunda M, Hinsenkamp M (1998) Treatment of chronic osteomyelitis using the Papineau technique. Int Orthop 22:37–40

    Article  PubMed  CAS  Google Scholar 

  4. Kınık H, Karaduman M (2008) Cierny-Mader Type III chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics. Int Orthop 32:551–558

    Article  PubMed  Google Scholar 

  5. Haidar R, Der Boghossian A, Atiyeh B (2010) Duration of post-surgical antibiotics in chronic osteomyelitis: empiric or evidence-based? Int J Infect Dis 14:752–758

    Article  Google Scholar 

  6. Sun Y, Zhang C, Jin D, Sheng J, Cheng X, Liu X et al (2010) Free vascularised fibular grafting in the treatment of large skeletal defects due to osteomyelitis. Int Orthop 34:425–430

    Article  PubMed  Google Scholar 

  7. Alonge TO, Ogunlade SO, Omololu AB (2003) The Belfast technique for the treatment of chronic osteomyelitis in a tropical teaching hospital. Int Orthop 27:125–128

    PubMed  CAS  Google Scholar 

  8. Lazzarini L, Lipsky BA, Mader JT (2005) Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials? Int J Infect Dis 9:127–138

    Article  PubMed  CAS  Google Scholar 

  9. Conterno LO, da Silva Filho CR (2009) Antibiotics for treating chronic osteomyelitis in adults. Cochrane Database Syst Rev 3:CD004439

    Google Scholar 

  10. Dellamonica P, Bernard E, Etesse H, Garraffo R, Drugeon HB (1989) Evaluation of pefloxacin, ofloxacin and ciprofloxacin in the treatment of thirty-nine cases of chronic osteomyelitis. Eur J Clin Microbiol Infect Dis 8:1024–1030

    Article  PubMed  CAS  Google Scholar 

  11. Matthews PC, Conlon CP, Berendt AR, Kayley J, Jefferies L, Atkins BL et al (2007) Outpatient parenteral antimicrobial therapy (OPAT): is it safe for selected patients to self-administer at home? A retrospective analysis of a large cohort over 13 years. J Antimicrob Chemother 60:356–362

    Article  PubMed  CAS  Google Scholar 

  12. Mader JT, Shirtliff ME, Bergquist SC, Calhoun J (1999) Antimicrobial treatment of chronic osteomyelitis. Clin Orthop Relat Res 360:47–65

    Article  PubMed  Google Scholar 

  13. Eyichukwu GO, Anyaehie UE (2009) Outcome of management of chronic osteomyelitis at National Orthopaedic Hospital, Enugu. Niger J Med 18:194–198

    PubMed  CAS  Google Scholar 

  14. Tice AD, Hoaglund PA, Shoultz DA (2003) Risk factors and treatment outcomes in osteomyelitis. J Antimicrob Chemother 51:1261–1268

    Article  PubMed  CAS  Google Scholar 

  15. Bernard L, El-Hajj PB, Lotthé A, Gleizes V, Signoret F et al (2001) Outpatient parenteral antimicrobial therapy (OPAT) for the treatment of osteomyelitis: evaluation of efficacy, tolerance and cost. J Clin Pharm Ther 26:445–451

    Article  PubMed  CAS  Google Scholar 

  16. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  17. Clinical Laboratory Standard Institution (2007) Performance standards for antimicrobial susceptibility testing; seventeenth informational supplement. M100-S17. CLSI, Wayne, PA

  18. Papineau LJ, Alfageme A, Dalcourt JP, Pilon L (1979) Chronic osteomyelitis: open excision and grafting after saucerization. Int Orthop 3:165–176

    Article  PubMed  CAS  Google Scholar 

  19. Martini M, Adjrad A, Boudjemaa A (1986) Tuberculous osteomyelitis. A review of 125 cases. Int Orthop 10:201–207

    PubMed  CAS  Google Scholar 

  20. Vittinghoff E, McCulloch CE (2007) Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 165:710–718

    Article  PubMed  Google Scholar 

  21. Cierny G, IIIrd MJT, Penninck JJ (2003) A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res 414:7–24

    Article  PubMed  Google Scholar 

  22. Uçkay I, Assal M, Legout L, Rohner P, Stern R, Lew D et al (2006) Recurrent osteomyelitis caused by infection with different bacterial strains without obvious source of reinfection. J Clin Microbiol 44:1194–1196

    Article  PubMed  Google Scholar 

  23. Toma MB, Smith KM, Martin CA, Rapp RP (2006) Pharmacokinetic considerations in the treatment of methicillin-resistant Staphylococcus aureus osteomyelitis. Orthopedics 29:497–501

    PubMed  Google Scholar 

  24. Cordero-Ampuero J, Esteban J, Garcia-Cimbrelo E (2009) Oral antibiotics are effective for highly resistant hip arthroplasty infections. Clin Orthop Relat Res 467:2335–2342

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are indebted to Gilles Cohen and Christophe Baréa for data retrieval. We thank the teams of the Orthopedic Service and the Laboratory of Bacteriology for their support.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland

    Thierry Rod-Fleury, Mathieu Assal, Louis Bernard, Pierre Hoffmeyer & Ilker Uçkay

  2. Department of Infectious Diseases, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland

    Nathalie Dunkel, Daniel Lew & Ilker Uçkay

  3. Coding Office, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Peter Rohner & Phedon Tahintzi

  4. Department of Infectious Diseases, Bretionneau Hospital, University of Tours, Tours, France

    Louis Bernard

Authors
  1. Thierry Rod-Fleury
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nathalie Dunkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mathieu Assal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Rohner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Phedon Tahintzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Louis Bernard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pierre Hoffmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniel Lew
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ilker Uçkay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ilker Uçkay.

Additional information

Thierry Rod-Fleury and Nathalie Dunkel contributed equally to this work.

The material presented in this paper has not been previously published, and is not being submitted elsewhere. The data presented is the work of all authors listed. The authors have no conflict of interest or financial interest in connection with this work and all authors have seen, approved, and contributed to the manuscript. There was no funding of this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rod-Fleury, T., Dunkel, N., Assal, M. et al. Duration of post-surgical antibiotic therapy for adult chronic osteomyelitis: a single-centre experience. International Orthopaedics (SICOT) 35, 1725–1731 (2011). https://doi.org/10.1007/s00264-011-1221-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-011-1221-y

Keywords

Search

Navigation