Cureus
Surgery, Washington University, Barnes-Jewish Hospital, St. Louis, USA.
Published: November 2018
Osteomyelitis is a progressively destructive invasive infection of the bone that can result in both localized and systemic illness. This includes an acute suppurative infection, generalized weakness, a failure to thrive, a pathological fracture, and non-healing ulcers. When chronic osteomyelitis develops, therapeutic options are limited, as antimicrobial agents cannot penetrate the necrotic bone, and repeated surgical debridement may be needed. Re-establishing full thickness coverage of the wounds and ulcers associated with osteomyelitis is challenging due to factors such as ongoing pressure injury, malnutrition, and resistant microorganisms. Classically, Girdlestone pseudoarthroplasty has been used to manage a resistant and invasive infection of the acetabular cavity and proximal femur, but it is now rarely employed because of the morbidity of removing the femoral head and leaving a wound to heal by secondary intention. Negative pressure wound therapy with instillation and dwell (NPWTi-d) offers a powerful adjunct to the management of complex infections and wound healing. In this case series of invasive osteomyelitis of the proximal femur in non-ambulatory patients, we demonstrate that the combination of the Girdlestone and negative pressure wound therapy with instillation and dwell allows for delayed closure within a week of the initial procedure, with favorable outcomes and no recurrence of osteomyelitis. The case log of a single surgeon was analyzed retrospectively over an 18-month period. The case series includes all patients who underwent the Girdlestone procedure for invasive osteomyelitis of the femoral head after failed antibiotic management, were non-ambulatory, and were greater than age 18. A total of 10 patients with 11 Girdlestone operations were found. Patients were predominantly male. The average age was 40 years. All patients were treated with NPWTi-d and then underwent a delayed primary or partial closure on an average of 4.5 days after the initial debridement. All four patients with no pre-existing pressure ulceration of the greater trochanter underwent primary closure without wound complication. Of the remaining patients with pre-operative ulcers of the greater trochanter, three were closed successfully or completely healed secondarily and four had substantial wound healing and reduction in size in the post-operative time period. All but one patient who had pre-operative ulcers of the ipsilateral ischium also had a noted improvement of ulcer dimensions in the postoperative follow-up period. Two patients developed new pressure ulcers on the contralateral side and two patients had a worsening of their pre-existing contralateral pressure ulcers more than 30 days post-operatively. No patient had a recurrence of their osteomyelitis. During the same time period, one patient refused surgical intervention and died secondary to overwhelming sepsis. Girdlestone pseudoarthroplasty is a radical therapy for refractory invasive osteomyelitis. While it has been historically associated with prolonged or failed wound healing, combining this surgery with negative pressure wound therapy with instillation and dwell allows for the successful eradication of infection. In addition, this facilitates wound healing and closure, providing a powerful alternative to the challenge of refractory invasive osteomyelitis of the hip, an ultimately life-threatening infection.
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http://dx.doi.org/10.7759/cureus.3552 | DOI Listing |
Microorganisms
December 2024
Department Poultry Health, Royal GD, 7418 EZ Deventer, The Netherlands.
Some strains of can cause spondylitis and bacterial osteomyelitis. Translocation and bacteremia are pivotal to the pathogenesis and clinical disease. Virulence typing to distinguish extra-intestinal disease of lesion from cloacal strains remains difficult.
View Article and Find Full Text PDFAntibiotics (Basel)
January 2025
Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
Background: Clindamycin resistance among community-associated methicillin-resistant (CA-MRSA) complicates the management of a challenging infection. Little data exist to guide clinicians in the management of invasive clindamycin-resistant CA-MRSA infections in children and studies using oral regimens such as trimethoprim-sulfamethoxazole (TMP-SMX) and linezolid for treatment of these infections are limited. We sought to reevaluate antibiotic management among invasive CA-MRSA at a tertiary children's hospital.
View Article and Find Full Text PDFBMC Oral Health
January 2025
Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Bundang‑gu, 13620, Seongnam, Republic of Korea.
Background: This study aims to evaluate the clinical outcome of biofluorescent imaging system (BIS) guided MRONJ surgery through analyzing 3D volumetric changes in CBCT data of bone structure.
Methods: BIS-guided surgery for MRONJ surgery was performed by grinding red-fluorescent area from remained residual bone detected by Qray-pen. CBCT data was collected preoperatively, postoperatively, and at last follow-up more than 3 months of each patient.
Front Immunol
January 2025
Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China.
Signal transducer and activator of transcription 1 (STAT1) gene mutations have broad clinical phenotypes, classified by the inheritance pattern and functional state. Individuals with autosomal dominant STAT1 deficiency are more susceptible to intracellular bacteria, the hallmark of which is Mendelian susceptibility to mycobacterial diseases (MSMDs) that are associated with increased risks of invasive disease by weakly virulent mycobacteria. We report a novel heterozygous missense mutation in exon 23 of the STAT1 gene (NM_007315.
View Article and Find Full Text PDFClin Microbiol Rev
January 2025
Laboratory of Pathology of Implant Infections, Laboratory of Immunorheumatology and Tissue Regeneration, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
SUMMARY is a major human pathogen. It can cause many types of infections, in particular bacteremia, which frequently leads to infective endocarditis, osteomyelitis, sepsis, and other debilitating diseases. The development of secondary infections is based on the bacterium's ability to associate with endothelial cells lining blood vessels.
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