Department of infectious diseases, Hospices Civils de Lyon, Lyon, France.
CRIOAc Lyon, Regional reference center for the management of complex bone and joint infection, Hospices Civils de Lyon, Lyon, France.
BMC Infect Dis. 2018 Apr 10;18(1):166. doi: 10.1186/s12879-018-3076-y.
A two-stage surgical strategy (debridement-negative pressure therapy (NPT) and flap coverage) with prolonged antimicrobial therapy is usually proposed in pressure ulcer-related pelvic osteomyelitis but has not been widely evaluated.
Adult patients with pressure ulcer-related pelvic osteomyelitis treated by a two-stage surgical strategy were included in a retrospective cohort study. Determinants of superinfection (i.e., additional microbiological findings at reconstruction) and treatment failure were assessed using binary logistic regression and Kaplan-Meier curve analysis.
Sixty-four pressure ulcer-related pelvic osteomyelitis in 61 patients (age, 47 (IQR, 36-63)) were included. Osteomyelitis was mostly polymicrobial (73%), with a predominance of S. aureus (47%), Enterobacteriaceae spp. (44%) and anaerobes (44%). Flap coverage was performed after 7 (IQR, 5-10) weeks of NPT, with 43 (68%) positive bone samples among which 39 (91%) were superinfections, associated with a high ASA score (OR, 5.8; p = 0.022). An increased prevalence of coagulase negative staphylococci (p = 0.017) and Candida spp. (p = 0.003) was observed at time of flap coverage. An ESBL Enterobacteriaceae spp. was found in 5 (12%) patients, associated with fluoroquinolone consumption (OR, 32.4; p = 0.005). Treatment duration was as 20 (IQR, 14-27) weeks, including 11 (IQR, 8-15) after reconstruction. After a follow-up of 54 (IQR, 27-102) weeks, 15 (23%) failures were observed, associated with previous pressure ulcer (OR, 5.7; p = 0.025) and Actinomyces spp. infection (OR, 9.5; p = 0.027).
Pressure ulcer-related pelvic osteomyelitis is a difficult-to-treat clinical condition, generating an important consumption of broad-spectrum antibiotics. The lack of correlation between outcome and the debridement-to-reconstruction interval argue for a short sequence to limit the total duration of treatment.
在压力性溃疡相关的骨盆骨髓炎中，通常采用两阶段手术策略（清创-负压治疗（NPT）和皮瓣覆盖）并延长抗菌治疗，但尚未得到广泛评估。
本回顾性队列研究纳入了采用两阶段手术策略治疗的压力性溃疡相关骨盆骨髓炎的成年患者。使用二项逻辑回归和 Kaplan-Meier 曲线分析来评估是否存在再感染（即重建时出现的其他微生物学发现）和治疗失败的决定因素。
61 例患者中共有 64 例压力性溃疡相关骨盆骨髓炎（年龄 47 岁（IQR，36-63））。骨髓炎多为混合感染（73%），以金黄色葡萄球菌（47%）、肠杆菌科（44%）和厌氧菌（44%）为主。NPT 后 7（IQR，5-10）周进行皮瓣覆盖，其中 43（68%）例骨样本阳性，其中 39（91%）例为再感染，与较高的ASA 评分相关（OR，5.8；p=0.022）。在皮瓣覆盖时，凝固酶阴性葡萄球菌（p=0.017）和念珠菌属（p=0.003）的检出率增加。5 例（12%）患者中检出产 ESBL 肠杆菌科，与氟喹诺酮类药物的使用有关（OR，32.4；p=0.005）。治疗持续时间为 20（IQR，14-27）周，重建后 11（IQR，8-15）周。随访 54（IQR，27-102）周后，观察到 15 例（23%）治疗失败，与先前的压力性溃疡（OR，5.7；p=0.025）和放线菌属感染（OR，9.5；p=0.027）有关。
压力性溃疡相关的骨盆骨髓炎是一种难以治疗的临床疾病，会大量使用广谱抗生素。结果与清创至重建间隔之间缺乏相关性，这表明应采用短序列来限制治疗的总持续时间。
