Dinh Aurélien, D'anglejan Emma, Leliepvre Helene, Bouchand Frédérique, Marmouset Damien, Dournon Nathalie, Mascitti Hélène, Genet François, Herrmann Jean-Louis, Chaussard Haude, Duran Clara, Noussair Latifa
Infectious Disease Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France.
Physical Medicine and Rehabilitation, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France.
Open Forum Infect Dis. 2023 Feb 16;10(3):ofad088. doi: 10.1093/ofid/ofad088. eCollection 2023 Mar.
Osteomyelitis-complicating pressure ulcers are frequent among patients with spinal cord injuries (SCIs), and the optimal management is unknown. In our referral center, the current management is debridement and flap coverage surgeries, followed by a short antibiotic treatment. We aimed to evaluate patients' outcomes a year after surgery.
We performed a quasi-experimental retrospective before/after study on SCI patients with presumed osteomyelitis associated with perineal pressure ulcers. We included all patients who underwent surgery with debridement and flap covering, followed by effective antibiotic treatment, between May 1, 2016, and October 30, 2020. The effective antimicrobial treatment duration included the 10 days leading up to January 1, 2018 (before period), and the 5 to 7 days after (after period). We also compared the efficacy of 5-7-day vs 10-day antibiotic treatment and performed uni- and multivariable analyses to identify factors associated with failure.
Overall, 415 patients were included (77.6% male patients; mean age ± SD, 53.0 ± 14.4 years). Multidrug-resistant organisms (MDROs) were involved in 20.7% of cases. Favorable outcomes were recorded in 69.2% of cases: 117/179 (65.3%) in the 10-day treatment group vs 169/287 (71.9%) in the 5-7-day treatment group ( = .153). The only factor associated with failure in the multivariate analysis was a positive culture from suction drainage (odds ratio, 1.622; 95% CI, 1.005-2.617; = .046). Effective treatment duration >7 days and intraoperative samples negative for MDROs were not associated with better outcomes ( = .153 and = .241, respectively).
A treatment strategy combining surgical debridement and flap covering, followed by 5 to 7 days of effective antibiotic treatment seems safe.
骨髓炎并发压疮在脊髓损伤（SCI）患者中很常见，最佳治疗方案尚不清楚。在我们的转诊中心，目前的治疗方法是清创和皮瓣覆盖手术，随后进行短期抗生素治疗。我们旨在评估术后一年患者的预后情况。
我们对疑似患有与会阴压疮相关骨髓炎的SCI患者进行了一项准实验性回顾性前后对照研究。纳入了2016年5月1日至2020年10月30日期间所有接受清创和皮瓣覆盖手术并接受有效抗生素治疗的患者。有效抗菌治疗时长包括2018年1月1日前的10天（前期）以及之后的5至7天（后期）。我们还比较了5至7天与10天抗生素治疗的疗效，并进行单变量和多变量分析以确定与治疗失败相关的因素。
总共纳入了415例患者（男性患者占77.6%；平均年龄±标准差为53.0±14.4岁）。20.7%的病例涉及多重耐药菌（MDROs）。69.2%的病例获得了良好预后：10天治疗组中117/179例（65.3%），5至7天治疗组中169/287例（71.9%）（P = 0.153）。多变量分析中与治疗失败相关的唯一因素是负压引流培养结果为阳性（比值比，1.622；95%置信区间，1.005 - 2.617；P = 0.046）。有效治疗时长>7天以及术中样本MDROs检测为阴性与更好的预后无关（分别为P = 0.153和P = 0.241）。
手术清创和皮瓣覆盖联合5至7天有效抗生素治疗的策略似乎是安全的。
