Russell Clark D, Tsang Shao-Ting Jerry, Simpson Alasdair Hamish R W, Sutherland Rebecca K
NHS Lothian Infection Service, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, U.K.
University of Edinburgh Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh BioQuarter, Edinburgh, U.K.
J Bone Jt Infect. 2020 Mar 26;5(2):67-75. doi: 10.7150/jbji.41779. eCollection 2020.
: Pressure ulcer-related pelvic osteomyelitis is a relatively under-studied entity in the field of bone infection. We sought to add to the limited evidence base for managing this challenging syndrome. : Cases were identified retrospectively from a surgical database and hospital discharge codes at a U.K. tertiary centre (2009-2018). Risk factors associated with outcomes were analysed by logistic regression. : We identified 35 patients (mean age 57.4 years), 69% managed with a combined medical and surgical approach, with mean follow-up of 3.7 years from index admission. Treatment failure (requiring further surgery or intravenous antimicrobials) occurred in 71% and eventual ulcer healing in 36%. One-year mortality was 23%. Lack of formal care support on discharge, post-traumatic (asensate) neurological deficit and index CRP (>184mg/L) were associated with treatment failure (p=0.001). Age (>59.5 years), lack of attempted soft tissue coverage, haemoglobin (<111g/L) and albumin (<25g/L) were associated with non-healing ulcers (p=0.003). Superficial wound swabs had low sensitivity and specificity compared to deep bone microbiology. Infection (based on deep bone microbiology from 46 infection episodes) was usually polymicrobial (87%), commonly involving , Enterococci, GNB and anaerobes. Antimicrobial duration ranged from 0-103 days (mean 54) and was not associated with subsequent treatment failure. : Attempted soft tissue coverage after surgical debridement, ensuring appropriate support for personal care after discharge and nutritional optimisation could improve outcomes. Superficial wound swabs are uninformative and deep bone sampling should be pursued. Long antimicrobial courses do not improve outcomes. Clinicians should engage patients in anticipatory care planning.
压力性溃疡相关的骨盆骨髓炎是骨感染领域中一个研究相对较少的实体。我们试图为管理这一具有挑战性的综合征增加有限的证据基础。：通过回顾性研究从英国一家三级中心的手术数据库和医院出院编码中识别病例（2009 - 2018年）。通过逻辑回归分析与结局相关的危险因素。：我们识别出35例患者（平均年龄57.4岁），69%采用药物和手术联合治疗方法，自首次入院起平均随访3.7年。71%的患者治疗失败（需要进一步手术或静脉使用抗菌药物），36%的患者溃疡最终愈合。1年死亡率为23%。出院时缺乏正式护理支持、创伤后（感觉缺失）神经功能缺损和首次入院时的C反应蛋白（>184mg/L）与治疗失败相关（p = 0.001）。年龄（>59.5岁）、未尝试进行软组织覆盖、血红蛋白（<111g/L）和白蛋白（<25g/L）与溃疡不愈合相关（p = 0.003）。与深部骨微生物学相比，浅表伤口拭子的敏感性和特异性较低。感染（基于46次感染发作的深部骨微生物学）通常为多微生物感染（87%），常见病原体包括肠球菌、革兰氏阴性菌和厌氧菌。抗菌药物使用时长从0至103天不等（平均54天），且与随后的治疗失败无关。：手术清创后尝试进行软组织覆盖、确保出院后个人护理得到适当支持以及优化营养状况可能会改善结局。浅表伤口拭子提供的信息不足，应进行深部骨采样。长疗程抗菌药物治疗并不能改善结局。临床医生应让患者参与预期护理计划。
