References

JBJI

Journal of Bone and Joint Infection

JBJI

J. Bone Joint Infect.

2206-3552

Ivyspring

Göttingen, Germany

10.7150/jbji.22566

Outcomes and Risk Factors for Polymicrobial Posttraumatic Osteomyelitis

Jorge

Luciana Souza

¹ Fucuta

Patrícia Silva

¹ L.

Maria Gabriele

² Nakazone

Marcelo Arruda

² de

Juliana Arruda

³ Chueire

Alceu Gomes

² Costa

Mauro José

⁴

Hospital de Base, Infection Control Unit, São José do Rio Preto Medical School, São Paulo, Brazil.

Orthopedics and Traumatology Unit, São José do Rio Preto Medical School, São Paulo, Brazil.

Instituto Nacional de traumatologia e Ortopedia (INTO); Rio de Janeiro, Brazil.

Division of Infectious Diseases, Department of Internal Medicine; Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.

20 02 2018

3 1 20 26

2018

This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

This article is available from https://jbji.copernicus.org/articles/3/20/2018/jbji-3-20-2018.html

The full text article is available as a PDF file from https://jbji.copernicus.org/articles/3/20/2018/jbji-3-20-2018.pdf

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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