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Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic‐loaded cement spacer for definitive bone defect treatment
AIMS: This study was designed to characterize the recurrence incidence and risk factors of antibiotic-loaded cement spacer (ALCS) for definitive bone defect treatment in limb osteomyelitis. METHODS: We included adult patients with limb osteomyelitis who received debridement and ALCS insertion into t...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The British Editorial Society of Bone & Joint Surgery
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10393517/ https://www.ncbi.nlm.nih.gov/pubmed/37527825 http://dx.doi.org/10.1302/2046-3758.128.BJR-2022-0413.R2 |
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author | Wu, Hongri Sun, Dong Wang, Shulin Jia, Chao Shen, Jie Wang, Xiaohua Hou, Chunli Xie, Zhao Luo, Fei |
author_facet | Wu, Hongri Sun, Dong Wang, Shulin Jia, Chao Shen, Jie Wang, Xiaohua Hou, Chunli Xie, Zhao Luo, Fei |
author_sort | Wu, Hongri |
collection | PubMed |
description | AIMS: This study was designed to characterize the recurrence incidence and risk factors of antibiotic-loaded cement spacer (ALCS) for definitive bone defect treatment in limb osteomyelitis. METHODS: We included adult patients with limb osteomyelitis who received debridement and ALCS insertion into the bone defect as definitive management between 2013 and 2020 in our clinical centre. The follow-up time was at least two years. Data on patients’ demographics, clinical characteristics, and infection recurrence were retrospectively collected and analyzed. RESULTS: In total, 314 patients with a mean age of 52.1 years (SD 12.1) were enrolled. After a mean of 50 months’ (24 to 96) follow-up, 53 (16.9%) patients had infection recurrence including 32 tibiae, ten femora, ten calcanea, and one humerus. Of all patients with recurrence, 30 (9.6%) occurred within one year and 39 (12.4%) within two years. Among them, 41 patients needed reoperation, five received antibiotics treatment only, and seven ultimately required amputations. Following multivariable analysis, we found that patients infected with Gram-negative bacilli were more likely to have a recurrence (odds ratio (OR) 2.38, 95% confidence interval (CI) 1.20 to 6.94; p = 0.046) compared to Staphylococcus aureus; segmental bone defects (OR 5.25, 95% CI 1.80 to 15.26; p = 0.002) and smoking (OR 3.00, 95% CI 1.39 to 6.50; p = 0.005) were also independent risk factors for recurrence after treatment. CONCLUSION: Permanent ALCS might be an alternative strategy for definitive bone defect management in selected osteomyelitis cases. However, the overall high recurrence found suggests that it should be cautiously treated. Additionally, segmental defects, Gram-negative infections, and smoking were associated with an increased risk of infection recurrence. Cite this article: Bone Joint Res 2023;12(8):467–475. |
format | Online Article Text |
id | pubmed-10393517 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | The British Editorial Society of Bone & Joint Surgery |
record_format | MEDLINE/PubMed |
spelling | pubmed-103935172023-08-02 Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic‐loaded cement spacer for definitive bone defect treatment Wu, Hongri Sun, Dong Wang, Shulin Jia, Chao Shen, Jie Wang, Xiaohua Hou, Chunli Xie, Zhao Luo, Fei Bone Joint Res Infection AIMS: This study was designed to characterize the recurrence incidence and risk factors of antibiotic-loaded cement spacer (ALCS) for definitive bone defect treatment in limb osteomyelitis. METHODS: We included adult patients with limb osteomyelitis who received debridement and ALCS insertion into the bone defect as definitive management between 2013 and 2020 in our clinical centre. The follow-up time was at least two years. Data on patients’ demographics, clinical characteristics, and infection recurrence were retrospectively collected and analyzed. RESULTS: In total, 314 patients with a mean age of 52.1 years (SD 12.1) were enrolled. After a mean of 50 months’ (24 to 96) follow-up, 53 (16.9%) patients had infection recurrence including 32 tibiae, ten femora, ten calcanea, and one humerus. Of all patients with recurrence, 30 (9.6%) occurred within one year and 39 (12.4%) within two years. Among them, 41 patients needed reoperation, five received antibiotics treatment only, and seven ultimately required amputations. Following multivariable analysis, we found that patients infected with Gram-negative bacilli were more likely to have a recurrence (odds ratio (OR) 2.38, 95% confidence interval (CI) 1.20 to 6.94; p = 0.046) compared to Staphylococcus aureus; segmental bone defects (OR 5.25, 95% CI 1.80 to 15.26; p = 0.002) and smoking (OR 3.00, 95% CI 1.39 to 6.50; p = 0.005) were also independent risk factors for recurrence after treatment. CONCLUSION: Permanent ALCS might be an alternative strategy for definitive bone defect management in selected osteomyelitis cases. However, the overall high recurrence found suggests that it should be cautiously treated. Additionally, segmental defects, Gram-negative infections, and smoking were associated with an increased risk of infection recurrence. Cite this article: Bone Joint Res 2023;12(8):467–475. The British Editorial Society of Bone & Joint Surgery 2023-08-02 /pmc/articles/PMC10393517/ /pubmed/37527825 http://dx.doi.org/10.1302/2046-3758.128.BJR-2022-0413.R2 Text en © 2023 Author(s) et al. https://creativecommons.org/licenses/by-nc-nd/4.0/https://online.boneandjoint.org.uk/TDMThis is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/ |
spellingShingle | Infection Wu, Hongri Sun, Dong Wang, Shulin Jia, Chao Shen, Jie Wang, Xiaohua Hou, Chunli Xie, Zhao Luo, Fei Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic‐loaded cement spacer for definitive bone defect treatment |
title | Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic‐loaded cement spacer for definitive bone defect treatment |
title_full | Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic‐loaded cement spacer for definitive bone defect treatment |
title_fullStr | Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic‐loaded cement spacer for definitive bone defect treatment |
title_full_unstemmed | Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic‐loaded cement spacer for definitive bone defect treatment |
title_short | Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic‐loaded cement spacer for definitive bone defect treatment |
title_sort | incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic‐loaded cement spacer for definitive bone defect treatment |
topic | Infection |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10393517/ https://www.ncbi.nlm.nih.gov/pubmed/37527825 http://dx.doi.org/10.1302/2046-3758.128.BJR-2022-0413.R2 |
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