Microbiology of unresolved bone infection: is it recurrence or recalcitrance?

Authors

Keywords:

unresolved bone infection, osteomyelitis, fracture-related infection, recurrence, recalcitrance

Abstract

Background: Bone infections are dreaded complications and remain a challenge for orthopaedic surgeons. Unresolved bone infection is caused by a broad spectrum of microorganisms; however, a few microorganisms persist from the initial infection. There are no published series reporting the microbiology in unresolved bone infection in low- or middle-income countries. This study aims to review the recurrence and recalcitrance of microorganisms in unresolved bone infection in the South African setting.

Methods: A single-centre retrospective cohort study reviews patients who underwent revision eradication surgery for unresolved bone infection between June 2016 and March 2023. Recalcitrance of bone infection was defined as the persistence of the same species of pathogen isolated at the time of index eradication surgery for bone infection. Recurrence was defined as a change in pathogen profile at the time of revision infection eradication surgery.

Results: Eleven patients had unresolved bone infections following eradication surgery. There were eight males and three females, with a mean age of 43.27 years (± 12.64 SD, range 25–58). The anatomical sites most frequently affected were the tibia (6/11, 55%) and femur (3/11, 27%). There is no statistically significant difference in the number of single species yielded (p = 0.586), polymicrobial species yielded (p = 1.0) or negative yield (p = 0.635) at secondary surgery. There is no similarity in the distribution of microorganisms at index surgery and secondary surgery. The causative pathogen for cases of unresolved bone infection had a higher probability to be different from the initial isolate obtained at the time of index surgery (73%), representing recurrence rather than persistence of the original infection.

Conclusion: This study reported a higher probability of encountering different species of microorganisms at secondary surgery as opposed to the recurrence of similar species. The culture obtained at index surgery is not a reliable predictor of microorganisms involved in unresolved bone infection. Therefore, new deep specimens are always required to determine the causative microorganism of unresolved bone infection.

Level of evidence: 4

Author Biographies

Adrian Jansen van Rensburg, Stellenbosch University

Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa

Jerry Tsang, Nuffield Orthopaedic Centre

Division of Orthopaedic Surgery, Trauma and Limb Reconstruction Surgery, John Radcliffe Hospital, Nuffield Orthopaedic Centre, Oxford, England

Rudolph G Venter, Stellenbosch University

Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa

Gadi Z Epstein, Stellenbosch University

Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa

Nando Ferreira, Stellenbosch University

Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa

Downloads

Published

2024-08-26

Issue

Section

Trauma

Most read articles by the same author(s)

1 2 > >>