Subject(s)
Bone Diseases, Infectious/drug therapy , Bone Diseases, Infectious/surgery , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/surgery , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Carbapenems/therapeutic use , Chronic Disease , Ciprofloxacin/therapeutic use , Combined Modality Therapy , Debridement , Drug Resistance, Multiple, Bacterial , Enterobacter cloacae , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
OBJECTIVE: We aimed to carry out a systematic assessment of gray-scale and color Doppler ultrasonography (CDUS) findings of reactivated post-traumatic/postoperative chronic osteomyelitis (COM) in adults. MATERIALS AND METHODS: Gray-scale and color Doppler ultrasonography were performed on 40 consecutive patients with a history of long-standing post-traumatic/post-operative chronic osteomyelitis and clinical suggestion of reactivation, in a 32-month-period. All patients had metallic implants: 16 internal fixations, nine external fixations, 11 hip arthroplasties and four knee arthroplasties. The final diagnosis of reactivated COM was based upon biopsy findings, with microbiological and histological examination (n = 27), or a combination of laboratory, clinical and magnetic resonance (MR) findings (n = 13). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of sonographic signs, including fistulous tracts, periosteal thickening, cortical discontinuity, soft tissue abscess and cellulitis, juxtacortical fluid, distension of the pseudocapsule in arthroplasties, and periosteal vascularity, were estimated. RESULTS: Statistically significant differences between patients with and without reactivated COM were found for fistulous tracts (P < 0.0001), juxtacortical fluid collections (P < 0.001) periosteal thickening (P < 0.01), distension of pseudocapsule (P < 0.05), and periosteal vascularity (P < 0.0001). Low-resistance arterial flow of periosteal vessels presented the highest sensitivity (92%), specificity, and PPV (100%), yielding only two false negative results in two obese patients. Among gray-scale findings, the presence of a fistulous tract yielded the highest specificity and PPV (100%), whereas periosteal thickening was the most sensitive (92%), though not specific, finding (specificity 50%). CONCLUSION: A constellation of gray-scale and CDUS findings can be highly indicative of reactivated bone infection in patients with long-standing chronic post-traumatic/post-operative osteomyelitis.
Subject(s)
Fractures, Bone/complications , Fractures, Bone/diagnostic imaging , Osteomyelitis/diagnostic imaging , Osteomyelitis/etiology , Postoperative Complications/diagnostic imaging , Ultrasonography, Doppler, Color/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
Complications of long-term linezolid administration include anemia and thrombocytopenia. A recent report has suggested that pyridoxine may prevent myelosuppression. Pyridoxine was administered to 24 patients with bone infections who were being treated with linezolid. Thrombocytopenia occurred in 11 patients (45.8%), and anemia occurred in 6 (25%). We concluded that treatment wtih pyridoxine is unlikely to benefit patients who have been receiving linezolid for >2 weeks.
