Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Geriatric Research Education and Clinical Center (GRECC) 111O (W), VA Northeast Ohio Healthcare System, 10701 East Blvd., Cleveland, OH, 44106, USA.
BMC Infect Dis. 2022 Mar 8;22(1):237. doi: 10.1186/s12879-022-07238-0.
Population-based surveillance studies may underestimate osteomyelitis caused by Group B Streptococcus (GBS). We analyzed cases of GBS osteomyelitis, including patients diagnosed using an expanded case definition that incorporates cultures from non-sterile sites, as well as cultures from normally sterile sites.
We retrospectively examined a cohort of veterans with the diagnosis of osteomyelitis between 2008 and 2017. Cases of definite GBS osteomyelitis required GBS isolation from normally sterile sites, (e.g., blood or bone). Cases of probable GBS osteomyelitis permitted GBS isolation from non-sterile sites (e.g., surgical sites, wounds). We compared comorbid conditions, lower extremity amputation and mortality rates in these groups.
Among 1281 cases of GBS osteomyelitis, the median age was 63 years, 87% had diabetes mellitus and 37% had peripheral vascular disease. Similar characteristics were found in 768 (60%) cases classified as definite and 513 (40%) classified as probable GBS osteomyelitis. Polymicrobial infection was less frequent in patients with definite than with probable GBS osteomyelitis (45% vs. 85%; P < 0.001). Mortality rates within 1-year were similar for definite and probable GBS osteomyelitis (12% vs. 10%). Amputation within 1-year occurred in 21% of those with definite and 10% of those with probable GBS osteomyelitis of the lower extremity, with comparable rates in the subset with monomicrobial infection.
Expanding the definition of GBS osteomyelitis to include cases with cultures from non-sterile sites may be warranted, increasing the estimated burden of GBS osteomyelitis. This can help guide preventive efforts to reduce the impact of GBS osteomyelitis.
基于人群的监测研究可能低估了 B 群链球菌（GBS）引起的骨髓炎。我们分析了 GBS 骨髓炎病例，包括使用纳入非无菌部位培养物的扩展病例定义诊断的患者，以及来自正常无菌部位的培养物。
我们回顾性检查了 2008 年至 2017 年间诊断为骨髓炎的退伍军人队列。明确的 GBS 骨髓炎病例需要从正常无菌部位（如血液或骨骼）分离出 GBS。可能的 GBS 骨髓炎病例允许从非无菌部位（如手术部位、伤口）分离出 GBS。我们比较了这两组患者的合并症、下肢截肢和死亡率。
在 1281 例 GBS 骨髓炎病例中，中位年龄为 63 岁，87%有糖尿病，37%有外周血管疾病。在归类为明确的 768 例（60%）和归类为可能的 513 例（40%）GBS 骨髓炎病例中，发现了相似的特征。在明确的 GBS 骨髓炎患者中，混合感染的频率低于可能的 GBS 骨髓炎患者（45%比 85%；P<0.001）。在 1 年内，明确和可能的 GBS 骨髓炎的死亡率相似（12%比 10%）。1 年内下肢明确和可能的 GBS 骨髓炎的截肢率分别为 21%和 10%，在单一微生物感染亚组中，截肢率相当。
将 GBS 骨髓炎的定义扩大到包括非无菌部位培养物的病例可能是必要的，这可能会增加 GBS 骨髓炎的估计负担。这有助于指导预防工作，以减少 GBS 骨髓炎的影响。
