Outcome and Predictors of Treatment Failure in Chronic Osteomyelitis Using Bioactive Glass Granules and Putty Formulations
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants/Study Subjects
2.3. Variables, Outcome Measures, and Data Sources
2.4. Surgical Management
2.5. Definitions
2.6. Specimen Collection and Microbiology
2.7. Statistical Analysis
3. Results
3.1. Study Population
3.2. Microbiological Findings
3.3. Six-Month Follow-Up Analyses (92 Patients)
3.4. Twelve-Month Follow-Up Analyses (78 Patients)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Demographics, Comorbidities, and Habits | N = 92 (%) |
---|---|
Gender | |
Male | 63 (68.5%) |
Age (mean (range)) (Years old) | 49 (34–64) |
<17 years | 5 (5.4%) |
18–39 years | 26 (28.3%) |
40–59 years | 35 (38.0%) |
60–79 years | 18 (19.6%) |
>80 years | 8 (8.7%) |
Chronic heart disease and/or hypertension | 22 (23.9%) |
Diabetes mellitus | 20 (21.7%) |
Smoking habits | 9 (9.8%) |
Thrombosis | 4 (4.3%) |
Paraplegia or quadriplegia | 4 (4.3%) |
Neoplasia | 3 (3.3%) |
Immunosuppression condition | 2 (2.2%) |
Alcoholism | 1 (1.1%) |
Osteomyelitis | |
Implant-free | 54 (58.7%) |
Implant-associated | 38 (41.3%) |
Pseudarthrosis | 14 (15.2%) |
Fistula | 15 (16.3%) |
Bioactive glass formulation | |
Granules and putty | 33 (35.9%) |
Putty (only) | 30 (32.6%) |
Granules (only) | 29 (31.5%) |
Duration of infection | |
<3 months | 37 (40.2%) |
>3 months | 55 (59.8%) |
Microorganisms | N = 69 (%) |
---|---|
Gram-positive cocci | 35 (50.7) |
Staphylococcus aureus | 19 (27.5) |
MRSA a | 5 (7.3) |
MSSA b | 2 (2.9) |
Coagulase-negative Staphylococci (CNS) | 10 (14.5) |
Staphylococcus epidermidis | 4 (5.8) |
Staphylococcus caprae | 1 (1.4) |
Staphylococcus haemolyticus | 1 (1.4) |
Staphylococcus xylosus | 1 (1.4) |
Staphylococcus lugdunensis | 3 (4.3) |
Enterococcus avium | 1 (1.4) |
Enterococcus faecalis | 1 (1.4) |
Enterococcus faecium | 1 (1.4) |
Streptococcus acidominimus | 1 (1.4) |
Streptococcus viridans | 1 (1.4) |
Gram-negative bacilli | 33 (47.8) |
Pseudomonas aeruginosa | 14 (20.3) |
Escherichia coli | 5 (7.2) |
Klebsiella pneumoniae | 6 (8.7) |
Acinetobacter baumannii | 2 (2.9) |
Proteus mirabilis | 2 (2.9) |
Klebsiella oxytoca | 1 (1.4) |
Morganella morganii | 1 (1.4) |
Enterobacter aerogenes | 1 (1.4) |
Enterobacter cloacae | 1 (1.4) |
Candida albicans | 1 (1.4) |
MDR c | 26 (37.7) |
Staphylococcus aureus | 10 (14.5) |
Pseudomonas aeruginosa | 5 (7.3) |
Klebsiella pneumoniae | 4 (5.8) |
Escherichia coli | 2 (2.9) |
Staphylococcus caprae | 1 (1.4) |
Staphylococcus epidermidis | 3 (4.3) |
Staphylococcus xylosus | 1 (1.4) |
Characteristics | Remission No. (%) (N = 79) | Failure No. (%) (N = 13) | p-Value |
---|---|---|---|
Bioactive glass | |||
Putty (only) | 28 (93.3%) | 2 (6.7%) | 0.058 * |
Granules and putty | 30 (90.9%) | 3 (9.1%) | |
Granules (only) | 21 (72.4%) | 8 (27.6%) | |
Duration of infection | |||
<3 months | 33 (89.2%) | 4 (10.8%) | 0.453 ** |
>3 months | 46 (83.6%) | 9 (16.4%) | |
Gram-positive cocci | |||
No | 51 (85.0%) | 9 (15.0%) | 1.000 * |
Yes | 28 (87.5%) | 4 (12.5%) | |
Staphylococcus spp. | |||
No | 55 (85.9%) | 9 (14,1%) | 1.000 * |
Yes | 24 (85.7%) | 4 (14.3%) | |
Gram-negative bacilli | |||
No | 57 (89.1%) | 7 (10.9%) | 0.204 * |
Yes | 22 (78.6%) | 6 (21.4%) | |
Nonfermenting Gram-negative bacilli | |||
No | 69 (89.6%) | 8 (10.4%) | 0.034 * |
Yes | 10 (66.7%) | 5 (33.3%) |
Variables | 6 Months | 12 Months | ||
---|---|---|---|---|
PR (CI 95%) | p-Value | PR (CI 95%) | p-Value | |
Smoking | 2.37 (0.55; 10.24) | 0.248 | 4.0 (1.03; 15.52) | 0.045 ** |
Nonfermenting Gram-negative bacilli | 3.92 (0.45; 33.91) | 0.215 | 3.87 (1.09; 13.73) | 0.036 ** |
Neoplasia | 5.26 (1.17; 23.73) | 0.031 ** | 2.64 (0.12; 57.66) | 0.538 |
Bioglass in granules | 3.44 (1.13; 10.52) | 0.030 ** | 3.04 (0.46; 19.84) | 0.246 |
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Share and Cite
Dell’Aquila, A.M.; Reis, G.N.B.d.; Cuba, G.T.; Targa, W.H.d.C.; Bongiovanni, J.C.; Durigon, T.S.; Salles, M.J.; Reis, F.B.d. Outcome and Predictors of Treatment Failure in Chronic Osteomyelitis Using Bioactive Glass Granules and Putty Formulations. Antibiotics 2023, 12, 1720. https://doi.org/10.3390/antibiotics12121720
Dell’Aquila AM, Reis GNBd, Cuba GT, Targa WHdC, Bongiovanni JC, Durigon TS, Salles MJ, Reis FBd. Outcome and Predictors of Treatment Failure in Chronic Osteomyelitis Using Bioactive Glass Granules and Putty Formulations. Antibiotics. 2023; 12(12):1720. https://doi.org/10.3390/antibiotics12121720
Chicago/Turabian StyleDell’Aquila, Adriana Macedo, Gabriela Nagy Baldy dos Reis, Gabriel Trova Cuba, Walter Hamilton de Castro Targa, José Carlos Bongiovanni, Thomas Stravinskas Durigon, Mauro José Salles, and Fernando Baldy dos Reis. 2023. "Outcome and Predictors of Treatment Failure in Chronic Osteomyelitis Using Bioactive Glass Granules and Putty Formulations" Antibiotics 12, no. 12: 1720. https://doi.org/10.3390/antibiotics12121720