Implant materials impregnated with antibiotics have long been used to manage the dead space created by debridement surgery in patients with osteomyelitis. To present our preliminary results and in vivo response of patients to PerOssal used to treat bone infection in the form of long bone chronic osteomyelitis. PerOssal is a new osteoconductive bone substitution material for bone filling which consists of an entirely synthetically produced, nanocrystalline hydroxyapatite and calcium sulfate. It can be used effectively as a local antibiotic carrier for the reconstruction of infected bone defects. We have treated 19 patients with long bone osteomyelitis (15 tibial, 4 femoral) with PerOssal impregnated with the appropriate antibiotic which was used following radical debridement surgery. In all cases we did not rely solely on the mechanical stability that it may provide but we supported the bone when necessary. Postoperative observations were focused on primary wound healing and clinical eradication of infection. We had: 15 eradication of infection, 2 recurrences, in terms of re-infection by different species or amputation, and 2 on-going cases. Declining wound leakage and delayed wound healing was present in 5 cases where PerOssal was used either intramedullarily but not sealed or extraosseously in relatively large amounts. We have so far good results with respect to infection control. PerOssal seems to perform better when used in contained defects whereas extraosseous use seems to predispose to prolonged leakage and compromised wound healing or breakdown. The mechanical stability that it provides remains under consideration.
The objective of the present study is to analyse the clinical, microbiological, and therapeutic features of patients with infective spondylodiscitis (ISD), who were followed up in our Outpatient Bone Infection Clinic. We retrospectively studied the epidemiological and clinical characteristics of all patients diagnosed with ISD from January 1998 to December 2006. Data were extracted from an electronic data base registry and patients’ files. Sixty patients either with spontaneous (n= 42, 70%) or postoperative (n= 18, 30%) ISD were evaluated. Population mean age was 56 years, 33 (55%) were male and 27 (45%) were female. The infection was localised in the lumbar (78%), thoracic (18%) or cervical (4%) spine. Predominate symptoms were pain (87%) and fever (50%). Fistula was observed exclusively in postoperative ISD (45%). In spontaneous ISD, the major causes were Brucella spp (33%), gram positive cocci (12%), gram negative bacteria (14%), Mycobacterium tuberculosis (7%), while in 33% of cases no pathogen was detected. In postoperative episodes of ISD the major causes were gram positive cocci (45%), gram negative bacteria (30%) and polymicrobial infection was documented in 22% of cases while in 25% of cases no pathogen was detected. Based on clinical, laboratory and imaging (especially MRI) data, treatment was individualised. Most patients (88%) received a combined antimicrobial treatment. Patients with spontaneous pyogenic/brucellosis or tuberculous/post-operative ISD received treatment for a median duration of 8/12/10 months and the response rate was 84%/81%/55.5%, respectively. Surgery was necessary in 40% of postoperative ISD cases for healing, while only one spontaneous case required a surgical intervention. ISD is more frequently localised at the lumbar level. Long term combination antimicrobial treatment may be essential. Surgery may be required in iatrogenic cases in the presence of foreign bodies.
