Bone infection associated with pressure sores: a clinical study

ABSTRACT

Pressure sores are common complications in patients with spinal injuries or cerebrovascular accidents. The management of pressure sores requires prolonged hospitalization and repeated surgical interventions with a high recurrence rate. Particularly osteomyelitis following initial pressure sores persistently complicates wound healing and recovery. Furthermore, it may also ultimately result in serious sepsis; thus an early diagnosis of osteomyelitis in pressure sore patients is crucial along with appropriate surgical and antibiotic therapy. Although many diagnostic methods were reported, there is no single 'gold' standard for early diagnosis of pressure sore-associated osteomyelitis. Authors reviewed pre-operative CBC, plain X-ray, Tc-99m bone scan, and post-operative biopsy results in 37 patients who had received surgical treatment for pressure sores in a 5-year period from September 1991 to August 1996. Based on these reviews, authors compared and analyzed the sensitivity and specificity in diagnosing osteomyelitis.The results were as follows 1. Of 37 patients studied, 25 cases were confirmed histologically as osteomyelitis. Ischial region revealed the highest incidence of pressure sore-related osteomyelitis(78%, 14 out of 18 cases) while the regional incidence was as following in descending order ischial, sacral, and greater trochanteric area. 2. Tc-99m bone scan had superior sensitivity(100%) and specificity(83%) to other pre-operative studies in diagnosing osteomyelitis.In conclusion, authors suggest that Tc-99m bone scan is the best diagnostic method because of its high sensitivity and specificity if osteomyelitis is clinically suspected in pressure sore patients. And in case the test result is positive, agressive surgical bone resection and appropriate antibiotic therapy based on bacterial culture from deep bone specimen should be combined to prevent complications or recurrences.