Antibiotic treatment regimens for bone infection after debridement: a study of 902 cases

Primary sternal osteomyelitis: A case report

INTRODUCTION

Primary sternal osteomyelitis is a rare condition that is frequently caused by Staphylococcus aureus. It is often confused with other cardiac and pulmonary conditions. Early antimicrobial treatment and surgical debridement is the cornerstone of treatment.

CASE PRESENTATION

A 51-year-old male adult came to the emergency room (ER) with a 2-week history of chest pain, fever, and malaise. His past medical history was unremarkable. Examination revealed a tender anterior chest wall swelling. White Blood Cells (WBCs) (21.6 × 104)/mm3) and C-reactive protein (CRP) (294.10 mg/L) were elevated. Pus from the swelling and blood samples were sent for culture and sensitivity. Electrocardiogram (ECG) was normal and a computed tomography (CT) scan of the chest showed a large dense anterior chest wall abscess extending deep in the chest and to both axillae which caused bony erosion of the sternum. Incision and drainage of the abscess were performed, followed by surgical debridement of the wound. Cultures along the course showed both Staphylococcus aureus and Enterococcus. The patient improved gradually and 2 months after his initial presentation, he became free of symptoms, and CT has shown complete resolution.

DISCUSSION

Osteomyelitis usually happens after an external bacterium seeds the bone where it begins to grow and thrive, leading to the destruction and pus accumulation under the periosteum. For the treatment, identifying the causative agent is critical in giving intravenous (IV) antibiotic. Thereafter, incision and drainage of an abscess can be performed, similar to what was done with the patient mentioned. Radiography, specifically a CT scan, is crucial as it clearly reveals bony margins and can differentiate between a sequestrum and an involucrum. It also identifies cortical erosion, intraosseous gases and periosteal reactions.

CONCLUSION

Sternal osteomyelitis can have a nonspecific clinical presentation. Laboratory investigations and radiological findings are crucial for a prompt diagnosis. To prevent the progression of the disease and complications, early intervention is vital to ensure a good prognosis.

Systemic Antimicrobial Treatment of Chronic Osteomyelitis in Adults: A Narrative Review

Chronic osteomyelitis in adults is a complex condition that requires prolonged and intensive antimicrobial therapy, but evidence on optimal selection and duration of antibiotics is limited. A review of PubMed and Ovid Embase databases was conducted to identify systematic reviews, meta-analyses, retrospective and randomised controlled trials (RCTs) on antibiotic treatment outcomes in adults with chronic osteomyelitis. Three main areas of interest were investigated: short-term versus long-term antibiotic therapy, oral versus parenteral antibiotic therapy, and combination antibiotic therapy with rifampicin versus without rifampicin. A total of 36 articles were identified and findings were synthesised using a narrative review approach. The available literature suffers from limitations, including a lack of high-quality studies, inconsistent definitions, and varying inclusion/exclusion criteria among studies. Most studies are open-labelled and lack blinding. Limited high-quality evidence exists that oral therapy is non-inferior to parenteral therapy and that shorter antibiotic duration might be appropriate in low-risk patients. Studies on the impact of rifampicin are inconclusive. Further well-designed studies are needed to provide more robust evidence in these areas.

Etiological spectrum and treatment outcome of wound infection in patients with open tibia and fibula fractures

OBJECTIVE

To explore the etiology of wound infections in patients with open tibia and fibula fractures and the treatment effects.

METHODS

In this retrospective study, a total of 76 patients with open tibia and fibula fractures were included in this research. These patients were divided into the control group (n=38) and the observation group (n=38) according to the treatment methods for wound infection. The distribution and drug resistance of pathogenic bacteria in wound infections were analyzed. Clinical effects, time for body temperature returning to normal, time for disappearance of exudates, time for clearance of pathogenic bacteria, recovery effects and patients' satisfaction rate were also compared between two groups.

RESULTS

A total of 152 strains of pathogenic bacteria were separated. The main pathogenic bacterium was Acinetobacter baumannii, accounting for 30.92% (47/152). Pathogenic bacteria were demonstrated to be highly sensitive to vancomycin and imipenem. The proportion of wound healing by first intention and the Johner-Wruhs scores in observation group were significantly higher than those in control group, while recurrent infection rate, the time to restore normal body temperature, the time for exudates to disappear, the time to remove pathogenic bacteria, hospital stays and VAS scores in observation group were obviously shorter or lower than those in control group (all P<0.05). Moreover, the satisfaction rate of patients in the observation group was significantly higher than that in the control group (P<0.05).

CONCLUSION

Understanding pathogenic characteristics and drug resistance of wound infection in patients with open tibia and fibula fractures is helpful to subsequent treatment. Comprehensive control measures should be taken to decrease incidence of wound infection.

Demonstrating the Potential of Using Bio-Based Sustainable Polyester Blends for Bone Tissue Engineering Applications

Healthcare applications are known to have a considerable environmental impact and the use of bio-based polymers has emerged as a powerful approach to reduce the carbon footprint in the sector. This research aims to explore the suitability of using a new sustainable polyester blend (Floreon™) as a scaffold directed to aid in musculoskeletal applications. Musculoskeletal problems arise from a wide range of diseases and injuries related to bones and joints. Specifically, bone injuries may result from trauma, cancer, or long-term infections and they are currently considered a major global problem in both developed and developing countries. In this work we have manufactured a series of 3D-printed constructs from a novel biopolymer blend using fused deposition modelling (FDM), and we have modified these materials using a bioceramic (wollastonite, 15% w/w). We have evaluated their performance in vitro using human dermal fibroblasts and rat mesenchymal stromal cells. The new sustainable blend is biocompatible, showing no differences in cell metabolic activity when compared to PLA controls for periods 1-18 days. FloreonTM blend has proven to be a promising material to be used in bone tissue regeneration as it shows an impact strength in the same range of that shown by native bone (just under 10 kJ/m2) and supports an improvement in osteogenic activity when modified with wollastonite.

Preparation and Characterization of Vancomycin Hydrochloride-Loaded Mesoporous Silica Composite Hydrogels

This study aims to explore the feasibility of the novel temperature-sensitive hydrogel-based dual sustained-release system (Van/SBA-15/CS-GP-SA) in the repair and treatment of infectious jaw defects. Van/SBA-15 was prepared using the mesoporous silica (SBA-15) as a carrier for vancomycin hydrochloride (Van), and Van/SBA-15 was characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy dispersive spectrometry (EDS), X-ray photoelectron spectroscopy (XPS), Fourier transform infrared (FTIR), Brunauer-Emmett-Teller (BET), and Barrett-Joyner-Halenda (BJH). The characterization results confirm that Van is loaded in SBA-15 successfully. Van/SBA-15/CS-GP-SA is constructed by encapsulating Van/SBA-15 in chitosan-sodium glycerophosphate-sodium alginate hydrogel (CS-GP-SA). The microstructures, sustained-release ability, biocompatibility, and antibacterial properties of Van/SBA-15/CS-GP-SA were systematically studied. Van/SBA-15/CS-GP-SA is found to have promising sustained-release ability, outstanding biocompatibility, and excellent antibacterial properties. This study provides new ideas for the management of infectious jaw defects.

Titania Nanotube Architectures Synthesized on 3D-Printed Ti-6Al-4V Implant and Assessing Vancomycin Release Protocols

The aim of this study is to synthesize Titania nanotubes (TNTs) on the 3D-printed Ti-6Al-4V surface and investigate the loading of antibacterial vancomycin drug dose of 200 ppm for local drug treatment application for 24 h. The antibacterial drug release from synthesized nanotubes evaluated via the chemical surface measurement and the linear fitting of Korsmeyer–Peppas model was also assessed. The TNTs were synthesized on the Ti-6Al-4V surface through the anodization process at different anodization time. The TNTs morphology was characterized using field emission scanning electron microscope (FESEM). The wettability and the chemical composition of the Ti-6Al-4V surface and the TNTs were assessed using the contact angle meter, Fourier transform infrared spectrophotometer (FTIR) and the X-ray photoelectron spectroscopy (XPS). The vancomycin of 200 ppm release behavior under controlled atmosphere was measured by the high-performance liquid chromatography (HPLC) and hence, the position for retention time at 2.5 min was ascertained. The FESEM analysis confirmed the formation of nanostructured TNTs with vertically oriented, closely packed, smooth and unperforated walls. The maximum cumulative vancomycin release of 34.7% (69.5 ppm) was recorded at 24 h. The wetting angle of both Ti-6Al-4V implant and the TNTs were found below 90 degrees. This confirmed their excellent wettability.