Author:
Leung Andraay H.C.,Hawthorn Benjamin R.,Simpson A. Hamish R.W.
Abstract
The treatment of chronic osteomyelitis requires both appropriate surgical and antibiotic management.
Prolonged intravenous antibiotic therapy followed by oral therapy is widely utilised. Despite this, the long-term
recurrence rate can be up to 30%.
A cohort of 50 patients from a 7-year period, 2003 to 2010, with chronic osteomyelitis was identified. This cohort was
treated by surgical marginal resection in combination with local application of antibiotics (Collatamp G - gentamicin in a
collagen fleece), a short course of systemic antibiotics post-operatively and conversion to oral antibiotics on discharge.
Information was retrieved from case notes and computerized records. Outcomes from this cohort were compared with a
historical cohort treated with marginal resection followed by 6 weeks of systemic antibiotics and 6 weeks of oral
antibiotics.
The mean follow-up duration was 3.2 years (SD 1.8). The average length of admission was 9.8 days (SD 11.4). 6 patients
(12%) suffered recurrence of infection requiring further treatment. We used the Cierny and Mader classification to stratify
the patients. 'A' hosts had a shorter duration of admission (7.1 days) than 'B' hosts (12.3 days). There was no significant
difference between recurrence rates of 'A' and 'B' hosts. Where available, we found pre-operative C-reactive protein (CRP)
and erythrocyte sedimentation rate (ESR) levels had no correlation with disease recurrence. Disease-free probability for
this cohort compared favourably with the historical cohort.
We believe local administration of gentamicin in a collagen fleece is a useful component in the management of chronic
osteomyelitis.
Publisher
Bentham Science Publishers Ltd.
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