TABLE 1.

Cases of fungal osteomyelitis in immunocompetent patients where polyhexamethylene biguanide (PHMB) was used as a component of treatment

Reference	Age (years), sex	Predisposing factors	Osteomyelitis site	Causative organism	Time from trauma to surgery + antifungal + PHMB	Treatment		Use of PHMB	Outcome	Follow-up (months)
						Antifungal (duration)	Surgery
Steinbach et al (2), 2003 (patient 1)	5M	Trauma – stepped on nail in chicken coop	Left navicular, talus, calcaneus, cuboid and cuneiforms	Scedosporium prolificans	96 days	Voriconazole and caspofungin (6 weeks)	Debridement	Intraoperative irrigation of surgical site with 0.2% PHMB (4 min)	Cure	11
Chang et al (3), 2005 (patient 2)	M*	Right tympanoplasty for tympanic membrane perforation as a child, previous grommets (no longer in situ)	Right mastoid	Lecythophora hoffmannii	>2 years	Itraconazole; betadine infusions, hydrogen peroxide/topical agents middle ear space (2 years)	Initial right tympano-mastoidectomy, later radical right tympano-mastoidectomy; then 7 revision procedures	PHMB 0.02% irrigation mastoid and middle ear cavity via perforated catheter – ‘several times a day’ (8 weeks)	Relapse (2 months later)	–
						After relapse: antifungal treatment not commented on	After relapse: right radical meatoplasty, revision mastoidectomy, debridement mastoid, middle ear	PHMB 0.02% irrigation right ear cavity daily; cavity packed with PHMB-soaked dressings (‘several months’)	Cure	>12
Kooijman et al (7), 2007 (patient 3)	36M	Traumatic below-knee amputation (agricultural equipment), wounds contaminated with manure	Right femur	Scedosporium aurantiacum	105 days	Voriconazole (12 weeks)	Initial debridement infected bone. Later debridement of abscess in the femoral stump	Wound soaked in 0.2% PHMB at surgery	Cure	11
Kesson et al (8), 2009 (patient 4)	8M	Trauma – compound fracture right iliac wing (agricultural equipment)	Right acetabulum, iliac wing, femoral head	S prolificans	72 days	Voriconazole (12 months) Terbinafine (14 months) Hexadecyl-phospocholine (13 months)	Debridement bone, joint capsule, wash out right hip	PHMB 0.2% lavage of hip and wound intra-operatively and 3 times/week (2 weeks)	Cure	23
2012 (case 1/patient 5)†	35F	Probable trauma – stepped on needle	Right calcaneus	Fusarium solani	>10 years	Voriconazole (13 months)	Debridement calcaneus	Intraoperative irrigation of calcaneus with PHMB 0.2% (4 min)	Relapse (4 years later)	48
2012 (case 2/patient 6)†	5M	Trauma – compound fractures fingers contaminated with soil	Left index and middle fingers	S prolificans, Scedosporium apiospermum	19 days	Voriconazole and terbinafine (6 weeks)	Debridement thumb and fingers, removal of external fixator	Wounds soaked in 0.2% PHMB 3 times/week (3 weeks)	Cure	24

^*Age reported as ‘adolescent’;

^†Present study. F Female; M Male