JAC Advance Access originally published online on March 28, 2003
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Journal of Antimicrobial Chemotherapy (2003) 51, 1261-1268
© 2003 The British Society for Antimicrobial Chemotherapy
Risk factors and treatment outcomes in osteomyelitis
1 Infections Limited, P.S., Tacoma, WA; 2 OPAT Outcomes Registry, Tacoma, WA; 3 PPD Development, Wilmington, NC; 4 Department of Epidemiology, University of Washington, Seattle, WA, USA
Received 15 July 2002; returned 8 November 2002; revised 19 December 2002; accepted 3 February 2003
Outcome indicators of recurrence and amputation were used to evaluate risk factors and treatment choices in 454 patients with osteomyelitis who completed outpatient parenteral antimicrobial therapy (OPAT). Three hundred and fifteen (69.4%) were apparently cured at the time outcomes were measured and 139 (30.6%) had a recurrence. Of the recurrences, 56% occurred within 3 months, 78% within 6 months and 95% within 1 year. Both the initial pathogen and the choice of antibiotic had an effect on the risk of treatment failure. Osteomyelitis caused by Pseudomonas aeruginosa was associated with more than a two-fold increase in recurrence (P = 0.005) compared with infection caused by Staphylococcus aureus. There was a positive correlation between P. aeruginosa and amputation. With S. aureus infections, the risk of recurrence was more than twice as great with vancomycin therapy as opposed to treatment with ß-lactams (P = 0.03). Treatment with ceftriaxone was as effective as the penicillinase-resistant penicillins and cefazolin.
Keywords: osteomyelitis, outcomes
* Corresponding author. Tel: +1-253-274-0833; Fax: +1-253-274-0877; E-mail: alantice{at}idlinks.com
Present address. John A. Burns School of Medicine, University of Hawaii, University Tower—7th floor, 1356 Lusitana Street, Honolulu, HI 96813, USA.
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