Table 1.
Demographic, clinical, microbiological and therapeutic features of the patients according to the outcome
| Relapse (n = 26) | No relapse (n = 90) | P | ||
|---|---|---|---|---|
| Gender | Male | 16 (18.6%) | 70 (81.4%) | 0.096 |
| Female | 10 (33.3%) | 20 (66.7%) | ||
| Age | Years | 57.42 (51.13–63.72) | 51.67 (47.93–55.40) | 0.14 |
| Origin/source | Hematogenous | 4 (20.0%) | 16 (80.0%) | 0.5 |
| Post-traumatic | 12 (19.4%) | 50 (80.6%) | ||
| Post-surgical | 10 (29.4%) | 24 (70.6%) | ||
| Bones involved | Femur | 6 (22.2%) | 21 (77.8%) | 0.9 |
| Tibia | 17 (23.6%) | 55 (76.4%) | ||
| Fibula | 1 (16.7%) | 5 (83.3%) | ||
| Humerus | 0 (0%) | 3 (100%) | ||
| Ulna | 1 (20.0%) | 4 (80.0%) | ||
| Radius | 1 (33.3%) | 2 (66.7%) | ||
| Imaging (other than radiographs) | Yes | 20 (28.2%) | 51 (71.8%) | 0.06 |
| No | 6 (13.3%) | 39 (86.7%) | ||
| C Reactive Protein (C-RP) | mg/L | 8.865 (.357–17.373) | 6.440 (4.739–8.1395) | 0.6 |
| Erythrocyte sedimentation rate (ESR) | mm/h | 53.52 (37.26–69.78) | 65.01 (57.20–72.82) | 0.18 |
| Duration of follow-up | Months | 56.12 (37.80–74.43) | 70.28 (58.67–81.89) | 0.24 |
| Severity factors | ||||
| Relapse of previous osteomyelitis | Yes | 14 (28.6%) | 35 (71.4%) | 0.17 |
| No | 12 (17.9%) | 55 (82.1%) | ||
| Symptoms longer than 3 months | Yes | 22 (28.6%) | 55 (71.4%) | 0.025 |
| No | 4 (10.3%) | 35 (89.7%) | ||
| Presence of osteosynthesis material | Yes | 13 (22.0%) | 46 (78.0%) | 0.9 |
| No | 13 (22.8%) | 44 (77.2%) | ||
| Bone exposure | Yes | 12 (26.1%) | 34 (73.9%) | 0.4 |
| No | 14 (20.0%) | 56 (80.0%) | ||
| Vascular involvement | Yes | 5 (45.5%) | 6 (54.5%) | 0.067 |
| No | 21 (20.0%) | 84 (80.0%) | ||
| Diabetes | Yes | 3 (30.0%) | 7 (70.0%) | 0.7 |
| No | 23 (21.7%) | 83 (78.3%) | ||
| Multiresistant/polymicrobial infection | Yes | 12 (23.5%) | 39 (76.5%) | 0.8 |
| No | 14 (21.5%) | 51 (78.5%) | ||
| Immunosuppression | Yes | 2 (50.0%) | 2 (50.0%) | 0.22 |
| No | 24 (21.4%) | 88 (78.6%) | ||
| Presence of severity factors | Yes | 12 (29.3%) | 29 (70.7%) | 0.19 |
| No | 14 (18.7%) | 61 (81.3%) | ||
| Types of severity factors | No | 14 (18.7%) | 61 (81.3%) | 0.4 |
| Local | 5 (22.7%) | 17 (77.3%) | ||
| Systemic | 4 (40.0%) | 6 (60.0%) | ||
| Both | 3 (33.3%) | 6 (66.7%) | ||
| Number of severity factors | 3.19 (2.69–3.69) | 2.49 (2.2–2.76) | 0.02 | |
| Microbiology | ||||
| Gram-positive cocci a | Gram-positive cocci | 17 (24.6%) | 52 (75.4%) | 0.8 |
| Others | 6 (27.3%) | 16 (72.7%) | ||
| Gram-negative bacilli a | Gram-negative bacilli | 9 (28.1%) | 23 (71.9%) | 0.8 |
| Others | 15 (25.4%) | 44 (74.6%) | ||
| Staphylococcus aureus a | S aureus | 12 (25.0%) | 36 (75.0%) | 0.9 |
| Others | 8 (23.5%) | 26 (76.5%) | ||
| Gram-pos cocci vs Gram-neg bacilli a | Gram-positive cocci | 14 (25.0%) | 42 (75.0%) | 0.8 |
| Gram-negative bacilli | 6 (27.3%) | 16 (72.7%) | ||
| Treatment | ||||
| Type of treatment | Antibiotics only | 6 (66.7%) | 3 (33.3%) | 0.004 |
| Antibiotics plus surgery | 20 (18.7%) | 87 (81.3%) | ||
| Intravenous beta-lactams | β-lactams | 5 (13.9%) | 31 (86.1%) | 0.7 |
| Other antibiotics | 4 (18.2%) | 18 (81.8%) | ||
| Oral β-lactams | β-lactams | 4 (23.5%) | 13 (76.5%) | 0.7 |
| Other antibiotics | 9 (17.3%) | 43 (82.7%) | ||
| Oral clindamycin | Clindamycin | 3 (10.7%) | 25 (89.3%) | 0.21 |
| Other antibiotics | 11 (22.0%) | 39 (78.0%) | ||
| Oral rifampin | Rifampin | 4 (15.4%) | 22 (84.6%) | 0.8 |
| Other antibiotics | 10 (19.2%) | 42 (80.8%) | ||
| Duration of intravenous antibiotics | Days | 26.44 (23.24–29.64) | 29.33 (27.09–31.58) | 0.21 |
| Total duration of antibiotic treatment | Days | 80.76 (36.05–125.47) | 69.58 (62.66–76.49) | 0.40 |
| Type of surgery | None | 6 (66.7%) | 3 (33.3%) | 0.004 |
| Debridement | 9 (19.6%) | 37 (80.4%) | ||
| Debridement and flap | 11 (18.0%) | 50 (82.0%) | ||
| Removal of osteosynthesis material b | Yes | 8 (19.0%) | 34 (81.0%) | 0.24 |
| No | 4 (36.4%) | 7 (63.6%) | ||
| Type of surgical reconstruction | None | 15 (27.3%) | 40 (72.7%) | 0.6 |
| Free muscle flap | 2 (14.3%) | 12 (85.7%) | ||
| Pedicled muscle flap | 4 (19.0%) | 17 (81.0%) | ||
| Free fasciocutaneous flap | 5 (23.8%) | 16 (76.2%) | ||
| Pedicled fasciocutaneous flap/rotation | 0 (0%) | 5 (100%) | ||
| Surgical reconstruction | Yes (all types of flaps) | 11 (18.0%) | 50 (82.0%) | 0.23 |
| No | 15 (27.3%) | 40 (72.7%) | ||
Values are expressed as mean (95% CI) or n (%) as appropriate
aThe comparisons of microorganisms/antibiotics have been carried out only in the cases in which the bacteria/antibiotic have been identified
bOnly in patients who had osteosynthesis material