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Journal of Bone and Joint Infection An open-access journal of the European Bone and Joint Infection Society and the MusculoSkeletal Infection Society
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Volume 3, issue 1
J. Bone Joint Infect., 3, 20–26, 2018
https://doi.org/10.7150/jbji.22566
© Author(s) 2018. This work is distributed under
the Creative Commons Attribution 4.0 License.
J. Bone Joint Infect., 3, 20–26, 2018
https://doi.org/10.7150/jbji.22566
© Author(s) 2018. This work is distributed under
the Creative Commons Attribution 4.0 License.

Original full-length article 20 Feb 2018

Original full-length article | 20 Feb 2018

Outcomes and Risk Factors for Polymicrobial Posttraumatic Osteomyelitis

Luciana Souza Jorge1, Patrícia Silva Fucuta1, Maria Gabriele L.2, Marcelo Arruda Nakazone2, Juliana Arruda de4, Alceu Gomes Chueire2, and Mauro José Costa3 Luciana Souza Jorge et al.
  • 1Hospital de Base, Infection Control Unit, São José do Rio Preto Medical School, São Paulo, Brazil.
  • 2Orthopedics and Traumatology Unit, São José do Rio Preto Medical School, São Paulo, Brazil.
  • 4Instituto Nacional de traumatologia e Ortopedia (INTO); Rio de Janeiro, Brazil.
  • 3Division of Infectious Diseases, Department of Internal Medicine; Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.

Keywords: Chronic osteomyelitis, polymicrobial infection, monomicrobial infection, posttraumatic osteomyelitis, risk factors, Staphylococcus aureus

Abstract. Background: We hypothesized that polymicrobial posttraumatic osteomyelitis (PTO) may be associated with worse outcomes when compared to monomicrobial PTO. We therefore attempted to show the outcomes and predisposing factors associated with polymicrobial PTO.

Methods: A single-center case-control study was carried out from 2007 to 2012. The outcome variables analyzed were: the need for additional surgical and antibiotic treatments, rates of amputation, and mortality associated with the infection. Univariate and multivariable analyses using multiple logistic regression were performed to identify risk factors associated with polymicrobial PTO, and p < 0.05 was considered significant.

Results: Among the 193 patients identified, polymicrobial PTO was diagnosed in 37.8%, and was significantly associated with supplementary surgical debridement (56.1% vs. 31%; p < 0.01), a higher consumption of antibiotics, and more amputations (6.5% vs 1.3%; p < 0.01). Factors associated with polymicrobial PTO in the multivariable analysis were older age (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 1.01 to 1.03, p = 0.04), working in agriculture (OR = 2.86, 95% CI = 1.05 to 7.79, p = 0.04), open fracture Gustilo type III (OR = 2.38, 95% CI = 1.02 to 5.56, p = 0.04), need for blood transfusion (OR = 2.15, 95% CI = 1.07 to 4.32, p = 0.03), and need for supplementary debridement (OR = 2.58, 95% CI = 1.29 to 5.16, p = 0.01).

Conclusions: PTO is polymicrobial in more than one-third of patients, associated with extra surgical and clinical treatment, and worse outcomes including higher rates of amputation.

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