Affiliation:
1. Divisions of Infectious Diseases and
2. Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
3. Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
Abstract
Abstract
Background. Decubitus ulcers can become complicated by pelvic osteomyelitis. Little is known about the epidemiology of pressure ulcer-related pelvic osteomyelitis.
Methods. We performed a retrospective cohort study of adult patients with pressure ulcer and pelvic osteomyelitis admitted to an academic center from 2006 to 2011. Data on clinical presentation, diagnostic evaluation, and treatment during the index admission were collected. Outcome measures included length of hospital stay and number of readmissions in the subsequent year.
Results. Two hundred twenty patients were included: 163 (74%) were para/quadriplegic and 148 (67%) were male (148; 67%). Mean age was 50 (±18) years. Pelvic osteomyelitis was the primary admission diagnosis for 117 (53%). Fifty-six (26%) patients had concurrent febrile urinary tract infection. Wound cultures collected for 113 patients (51%) were notable for methicillin-resistant Staphylococcus aureus (37; 33%), Streptococci (19; 17%), and Pseudomonas spp (20; 18%). Plain films were obtained in 89 (40%) patients, computed tomography scans were obtained for 81 (37%) patients, and magnetic resonance images were obtained for 40 (18%) patients. Most patients received osteomyelitis-directed antibiotics (153; 70%), 134 of 153 (88%) of which were scheduled to receive ≥6 weeks of treatment. Fifty-five (25%) patients underwent surgery during the index admission; 48 (22%) patients received a combined medical-surgical approach. One third of patients had ≥2 readmissions during the subsequent year. Patients treated with a combined approach were less likely to be readmitted than those who received antibiotics alone (0 [range, 0–4] vs 1 [0–7] readmissions; P = .04).
Conclusions. This is one of the largest cohort studies of pressure ulcer-related pelvic osteomyelitis to date. Significant variations existed in diagnostic approach. Most patients received antibiotics; those treated with a combined medical-surgical approach had fewer hospital readmissions.
Funder
KM1 Comparative Effectiveness Research Career Development Award
Clinical and Translational Science Award (CTSA) program
National Center for Advancing Translational Sciences (NCATS)
Barnes-Jewish Patient Safety & Quality Career Development Program
Foundation for Barnes-Jewish Hospital
National Institutes of Health (NIH)
CTSA/NCATS
KL2 Career Development
Building Interdisciplinary Research Careers in Women′s Health
NIH
NCATS
the Centers for Disease Control and Prevention, Prevention Epicenters Program
Barnes-Jewish Hospital Patient Safety & Quality Fellowship Program
Barnes-Jewish Hospital Foundation & Washington University′s Institute for Clinical and Translational Science
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology
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