Materiały źródłowe

• #1 Skeletal infections: microbial pathogenesis, immunity and clinical management | Nature Reviews Microbiology

  https://www.nature.com/articles/s41579-022-00686-0

  Osteomyelitis remains one of the greatest risks in orthopaedic surgery. […] However, little clinical progress has been made in the prevention and eradication of skeletal infection as treatment algorithms and outcomes have only incrementally changed over the past half century. […] Finally, we discuss the clinical management of skeletal infection, including osteomyelitis classification and strategies to treat skeletal infections with emerging technologies that could translate to the clinic in the future. […] Serum antibodies against Staphylococcus aureus can prognose treatment success in patients with bone infections. […] The prognosis of streptococcal prosthetic bone and joint infections depends on surgical management a multicenter retrospective study. […] Success rates of debridement, antibiotics, and implant retention in 230 infected total knee arthroplasties: implications for classification of periprosthetic joint infection. […] Current actual success rate of the two-stage exchange arthroplasty strategy in chronic hip and knee periprosthetic joint infection. […] Two-stage reimplantation of a prosthetic hip infection: systematic review of long-term reinfection and pathogen outcomes.

• #2 Evolving concepts in bone infection: redefining “biofilm”, “acute vs. chronic osteomyelitis”, “the immune proteome” and “local antibiotic therapy” | Bone Research

  https://www.nature.com/articles/s41413-019-0061-z

  Osteomyelitis is a devastating disease caused by microbial infection of bone. While the frequency of infection following elective orthopedic surgery is low, rates of reinfection are disturbingly high. Staphylococcus aureus is responsible for the majority of chronic osteomyelitis cases and is often considered to be incurable due to bacterial persistence deep within bone. Unfortunately, there is no consensus on clinical classifications of osteomyelitis and the ensuing treatment algorithm. Given the high patient morbidity, mortality, and economic burden caused by osteomyelitis, it is important to elucidate mechanisms of bone infection to inform novel strategies for prevention and curative treatment. […] Despite infection treatment strategies such as surgical site debridement, complete hardware exchange, and aggressive long-term antimicrobial therapy, infections continue to recur. In total, the cost for treatment of implant-associated osteomyelitis is projected to exceed $1.62 billion by 2020.

• #3 Can we predict outcome after treatment of long bone osteomyelitis? – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33135450/

  Aims: This study presents patient-reported quality of life (QoL) over the first year following surgical debridement of long bone osteomyelitis. It assesses the bone involvement, antimicrobial options, coverage of soft tissues, and host status (BACH) classification as a prognostic tool and its ability to stratify cases into 'uncomplicated’ or 'complex’. […] Conclusion: Uncomplicated osteomyelitis, as defined by BACH, gave higher self-reported QoL when compared to complex cases. The bone involvement, antimicrobial options, and host status variables were able to stratify patients in terms of QoL. These data can be used to offer prognostic information to patients who are undergoing treatment for long bone osteomyelitis.

• #4 Can we predict outcome after treatment of long bone osteomyelitis? | Bone & Joint

  https://boneandjoint.org.uk/Article/10.1302/0301-620X.102B11.BJJ-2020-0284.R1

  This study presents patient-reported quality of life (QoL) over the first year following surgical debridement of long bone osteomyelitis. […] Uncomplicated osteomyelitis, as defined by BACH, gave higher self-reported QoL when compared to complex cases. The bone involvement, antimicrobial options, and host status variables were able to stratify patients in terms of QoL. These data can be used to offer prognostic information to patients who are undergoing treatment for long bone osteomyelitis.

• #5 Can we predict outcome after treatment of long bone osteomyelitis? — Experimental Medicine Division

  https://www.expmedndm.ox.ac.uk/publications/1141453

  Uncomplicated osteomyelitis, as defined by BACH, gave higher self-reported QoL when compared to complex cases. […] The bone involvement, antimicrobial options, and host status variables were able to stratify patients in terms of QoL. […] These data can be used to offer prognostic information to patients who are undergoing treatment for long bone osteomyelitis.

• #6 Diagnosis and Management of Osteomyelitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1101/p1027.html

  The increased incidence of methicillin-resistant Staphylococcus aureus osteomyelitis complicates antibiotic selection. […] The recurrence rate remains high despite surgical intervention and long-term antibiotic therapy. […] Despite the use of surgical debridement and long-term antibiotic therapy, the recurrence rate of chronic osteomyelitis in adults is about 30 percent at 12 months. […] Recurrence rates in cases involving P. aeruginosa are even higher, nearing 50 percent. […] The optimal duration of antibiotic treatment and route of delivery are unclear. […] In some cases, surgery is necessary to preserve viable tissue and prevent recurrent systemic infection.

• #7 Evolving concepts in bone infection: redefining “biofilm”, “acute vs. chronic osteomyelitis”, “the immune proteome” and “local antibiotic therapy” | Bone Research

  https://www.nature.com/articles/s41413-019-0061-z

  An astounding 75% of osteomyelitis cases are caused by pathogens of the Staphylococcus genus. Specifically, Staphylococcus aureus is the most common pathogen isolated from implant-associated osteomyelitis and over 50% of cases are caused by hard-to-treat methicillin-resistant S. aureus (MRSA) strains. […] Remarkably, the results from the 2018 International Consensus Meeting on Musculoskeletal Infections reported no changes in PJI infection rates, the primary pathogen, treatment algorithm, and poor outcomes, since this original standard of care was established half a century ago. […] In a study investigating outcomes of 16,622 TKR infections, the results of this study showed that patients who underwent ID had the highest rate of infection recurrence (28.2%), whereas patients who underwent two-stage revision had the lowest rate of recurrence (19%) at 1 year.

• #8 Outcome and Predictors of Treatment Failure in Chronic Osteomyelitis Using Bioactive Glass Granules and Putty Formulations

  https://www.mdpi.com/2079-6382/12/12/1720

  BAG-S53P4 is a viable option for bone-void filling and the treatment of chronic cavitary osteomyelitis. […] The aim of this study was to evaluate the clinical outcome of patients with cOM treated with BAG-S53P4 granules and putty formulations and to assess the predisposing risk factors (RFs) for treatment failure in 6- and 12-month patient follow-ups. […] In the 6-month follow-up, BAG-S53P4 in the granule formulation presented a greater risk of recurrence compared to the bioactive glass putty formulation or combined granules and putty (prevalence ratio (PR) = 3.04; confidence interval 95% [CI95%]: 1.13–10.52) and neoplasia (PR = 5.26; CI95%: 1.17–15.52). […] In the 12-month follow-up cohort of 78 patients, smoking (PR = 4.0; 95% CI: 1.03–15.52) and nonfermenting GNB infection (PR = 3.87; CI95%: 1.09–13.73) presented a greater risk of recurrence.

• #9 Outcome and Predictors of Treatment Failure in Chronic Osteomyelitis Using Bioactive Glass Granules and Putty Formulations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10740565/

  In the survival analysis carried out to identify the independent risk factors related to time to recurrence of cOM, immunosuppressive drugs, the presence of cancer, and infection due to nonfermenting GNB negatively influenced the time to cOM with statistical significance. […] Interestingly, the bioglass-based putty showed a greater eradication of the infection when compared with the bioglass in granules.

• #9 Outcome and Predictors of Treatment Failure in Chronic Osteomyelitis Using Bioactive Glass Granules and Putty Formulations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10740565/

  BAG-S53P4 is a viable option for bone-void filling and the treatment of chronic cavitary osteomyelitis. Formulations of BAG with putty or in combination with granules showed better results. […] In the 6-month follow-up, BAG-S53P4 in the granule formulation presented a greater risk of recurrence compared to the bioactive glass putty formulation or combined granules and putty (prevalence ratio (PR) = 3.04; confidence interval 95% [CI95%]: 1.1310.52) and neoplasia (PR = 5.26; CI95%: 1.1715.52). […] In the 12-month follow-up cohort of 78 patients, smoking (PR = 4.0; 95% CI: 1.0315.52) and nonfermenting GNB infection (PR = 3.87; CI95%: 1.0913.73) presented a greater risk of recurrence. […] Patients treated with bioglass-based putty with or without granules in combination had a better outcome with lower recurrence rates (7.9%) when compared to the use of the granule formulation only (27.6%).

• #10 Outcome and Predictors of Treatment Failure in Chronic Osteomyelitis Using Bioactive Glass Granules and Putty Formulations

  https://www.mdpi.com/2079-6382/12/12/1720

  Despite all of the efforts in the surgical treatment of cOM with the use of local bone-void fillers with antibiotics, worryingly, rates of infection recurrence remain, including those associated with multidrug-resistant bacteria (MDR) in developing countries. […] The conventional treatment for cOM consists of the debridement of affected tissue and the addition of polymethylmethacrylate (PMMA) with local antibiotics, requiring at least two procedural steps—the first to allocate the PMMA with antibiotics and the second to remove the PMMA—since it is not a biodegradable material. […] Systemic and local antibiotic therapy with surgical debridement as a treatment for osteomyelitis, despite being associated with a satisfactory success rate, may fail in over 20% of cases. […] In this case series, no patient underwent extra surgeries. However, it is also important to assess the RFs associated with the recurrence of infection among patients to better target the indications for treatment with bioglass and increase the success rate with the product. […] The present study identified many MDR-GNB infections, such as Pseudomonas aeruginosa, with a high frequency of XDR strains.

• #11 Evolving concepts in bone infection: redefining “biofilm”, “acute vs. chronic osteomyelitis”, “the immune proteome” and “local antibiotic therapy” | Bone Research

  https://www.nature.com/articles/s41413-019-0061-z

  Regardless of the treatment chosen, rates of reinfection are alarmingly high, suggesting the need for continued research on novel diagnostics and therapeutics to combat recurrent infection. […] Collectively, these novel findings suggest that invasion and propagation within the immune-privileged OLCN is a pathogenic mechanism that renders S. aureus infection of bone incurable. Further, the long-term colonization of cortical bone by slow growing bacteria seems to be the most likely explanation for infection recurrence after decades of quiescence. […] Considering this new information on distinct biofilms in chronic osteomyelitis, including SACs and colonization of the OLCN of live bone, a major unmet clinical need is a diagnostic that can identify the existence of bone infection with spatial resolution, and assess the completeness of debridement following revision surgery.

• #12 Clinical outcomes of pediatric osteomyelitis | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03863-z

  Osteomyelitis in children may produce severe sequelae. However, the frequency and distribution of such complications by type of osteomyelitis (chronic or acute) is not well described. […] Though infrequent, serious outcomes from osteomyelitis are more common with chronic osteomyelitis than acute osteomyelitis. […] Osteomyelitis in children may be associated with poor outcomes and severe sequelae. […] Improved awareness of the frequency and types of sequelae associated with each presentation of osteomyelitis would help clinicians provide prognostic guidance and focus future research efforts towards the most relevant areas. […] We hypothesized that chronic osteomyelitis would be associated with significantly longer durations of hospital stay and higher frequencies of limb length discrepancies and pathologic fractures than acute osteomyelitis.

• #13 Clinical outcomes of pediatric osteomyelitis | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03863-z

  Though infrequent, we found a higher burden of severe sequelae in subjects with chronic osteomyelitis, a patient population which is understudied. […] Children with chronic osteomyelitis were significantly more likely to experience pathologic fractures than children with acute osteomyelitis, and more likely to require multiple surgeries than those with acute osteomyelitis. […] Children with chronic osteomyelitis were also significantly more likely to require long-term orthopedic follow-up than children with acute osteomyelitis, though given the chronic nature of the disease, this is not surprising. […] Complications from osteomyelitis in children are relatively rare, though appear more frequent in children with chronic osteomyelitis. Further study of chronic osteomyelitis in children is warranted.

• #14 Long-term follow-up of children with chronic non-bacterial osteomyelitis—assessment of disease activity, risk factors, and outcome | Arthritis Research & Therapy | Full Text

  https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03195-4

  An improvement of physician global disease activity (PGDA), patient reported overall well-being and imaging-defined disease activity measures was documented, suggesting that inactivity of CNO disease can be reached. […] Predictors associated with a severe disease course include the site of inflammation (pelvis, lower extremity, clavicle), increased erythrocyte sedimentation rate, and multifocal disease at first documentation. […] It was calculated that an ESR increase by 1 mm/h at inclusion may rise the risk for severe disease by 3%. For each additional MRI lesion, the risk for severe disease (PGDA4 over time) was elevated by 19%. […] We were able to identify outcome predictors for severe disease at disease onset like multifocal disease, elevated ESR, and certain bone lesions. Future investigations may help confirming these predictors in order to justify early treatment decisions.

• #15 Evolving concepts in bone infection: redefining “biofilm”, “acute vs. chronic osteomyelitis”, “the immune proteome” and “local antibiotic therapy” | Bone Research

  https://www.nature.com/articles/s41413-019-0061-z

  The recent breakthroughs in cancer immunotherapy, most notably checkpoint inhibitors, begs the question if similar advances could be made for osteomyelitis. Now that an important first step has been made by defining the host immune proteome against S. aureus, efforts are warranted to translate this new information into diagnostics and vaccines that can better detect ongoing infections, assess response to therapy, and develop adjuvants to antibiotic therapy.

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