Liu Zemin, Jin Guochao, Zhang Le, Zhang Ruqi, Wang Dong, Liu Min, Li Yan, Zhang Yonghong
Second Clinical Medical College, Shanxi Medical University, Taiyuan, China.
Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, China.
Front Public Health. 2025 Aug 29;13:1654861. doi: 10.3389/fpubh.2025.1654861. eCollection 2025.
The incidence of chronic osteomyelitis increases annually. Currently, epidemiological data on chronic osteomyelitis in Central China are scarce. Describing the epidemiological distribution, pathogens, and drug resistance characteristics of patients with chronic osteomyelitis in Central China is critical for its prevention and control. In this study, we aimed to statistically analyze patients with chronic osteomyelitis from four local hospitals to provide a reference for prevention and control in this region.
We conducted a retrospective analysis of the clinical data of patients with chronic osteomyelitis admitted to four hospitals in Central China between January 1, 2016, and December 31, 2021, using ICD codes in the electronic medical record system. Data extracted included patients' basic details, hospitalization records, infection status, and bacterial culture results. Statistical descriptions included pathogen detection, distribution, and changes. Furthermore, we analyzed the antibiotic resistance of Gram-positive and -negative bacteria. Patients with positive cultures underwent risk-factor analysis.
We included 632 patients with chronic osteomyelitis, comprising traumatic osteomyelitis (464 patients), hematogenous osteomyelitis (120 patients), and diabetic foot osteomyelitis (48 patients). The median age was 46 (IQR 30-58) years, and the majority were aged between 41 and 60 years. The male-to-female ratio was 2.49:1. Traffic accidents were identified as the primary etiological factor. The three most commonly affected sites were the tibia, femur, and calcaneus. Among the laboratory indicators, the erythrocyte sedimentation rate had the highest positive rate at 57.71%. Bacterial cultures were performed on the intraoperative specimens of 421 patients and yielded 292 positives (69.36%), of which we identified 386 isolates from 74 pathogens. The most prevalent pathogen were , , and spp. (132 [34.20%], 47 [12.18%], and 25 [6.47%] isolates). Gram-positive bacteria were resistant to conventional antibiotics, including penicillin, erythromycin, and clindamycin; however, they were susceptible to peptide antibiotics and oxazolidinones. Gram-negative bacteria were resistant to first- and second-generation cephalosporins; nevertheless, they were sensitive to third- and fourth-generation cephalosporins as well as combinations such as cefoperazone-sulbactam. Multivariate logistic regression analysis identified length of hospital stay (odds ratio [OR] = 1.037, = 0.001), diabetes (OR = 6.61, = 0.049), and smoking (OR = 6.873, = 0.003) as independent risk factors.
Chronic osteomyelitis predominantly affects middle-aged and older adults, males, and those with tibial injuries from traffic accidents requiring special attention. was associated with the highest risk of infection. Empirical early-phase medication should be followed by targeted antibiotic therapy based on bacterial sensitivity and resistance. Patients with prolonged hospitalization, diabetes, or a smoking history require special attention. Notably, strengthening health education and postoperative care in these patients can reduce the risk of chronic osteomyelitis.
慢性骨髓炎的发病率逐年上升。目前，中国中部地区关于慢性骨髓炎的流行病学数据匮乏。描述中国中部地区慢性骨髓炎患者的流行病学分布、病原体及耐药特征对其防控至关重要。在本研究中，我们旨在对来自四家当地医院的慢性骨髓炎患者进行统计分析，为该地区的防控工作提供参考。
我们利用电子病历系统中的ICD编码，对2016年1月1日至2021年12月31日期间在中国中部四家医院收治的慢性骨髓炎患者的临床资料进行回顾性分析。提取的数据包括患者的基本信息、住院记录、感染状况及细菌培养结果。统计描述包括病原体检测、分布及变化情况。此外，我们分析了革兰氏阳性菌和阴性菌的抗生素耐药性。对培养阳性的患者进行危险因素分析。
我们纳入了632例慢性骨髓炎患者，包括创伤性骨髓炎（464例）、血源性骨髓炎（120例）和糖尿病足骨髓炎（48例）。中位年龄为46岁（四分位间距30 - 58岁），大多数患者年龄在41至60岁之间。男女比例为2.49:1。交通事故被确定为主要病因。三个最常受累部位是胫骨、股骨和跟骨。在实验室指标中，红细胞沉降率的阳性率最高，为57.71%。对421例患者的术中标本进行细菌培养，292例呈阳性（69.36%），其中我们从74种病原体中鉴定出386株分离菌。最常见的病原体是[此处原文缺失具体病原体名称]、[此处原文缺失具体病原体名称]和[此处原文缺失具体病原体名称]菌属（分别为132株[34.20%]、47株[12.18%]和25株[6.47%]分离菌）。革兰氏阳性菌对包括青霉素、红霉素和克林霉素在内的传统抗生素耐药；然而，它们对肽类抗生素和恶唑烷酮敏感。革兰氏阴性菌对第一代和第二代头孢菌素耐药；不过，它们对第三代和第四代头孢菌素以及头孢哌酮 - 舒巴坦等联合用药敏感。多因素逻辑回归分析确定住院时间（比值比[OR]=1.037，P = 0.001）、糖尿病（OR = 6.61，P = 0.049）和吸烟（OR = 6.873，P = 0.003）为独立危险因素。
慢性骨髓炎主要影响中老年男性以及因交通事故导致胫骨受伤的人群，需要特别关注。[此处原文缺失具体内容]与最高感染风险相关。经验性早期用药后应根据细菌敏感性和耐药性进行针对性抗生素治疗。住院时间延长、患有糖尿病或有吸烟史的患者需要特别关注。值得注意的是，加强对这些患者的健康教育和术后护理可降低慢性骨髓炎的风险。
