Archive for June 14, 2012

Delayed primary versus late secondary wound closure in the treatment of postsurgical sternum osteomyelitis.

Interact Cardiovasc Thorac Surg. 2011 Jun  V.12 N.6 P.914-8.

Berdajs DA, Trampuz A, Ferrari E, Ruchat P, Hurni M, von Segesser LK.

Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland. denis.berdajs@chuv.ch

Abstract

Sternal osteomyelitis and poststernotomy mediastinitis is a severe and life-threatening complication after the cardiac surgery. The incidence ranges up to 3% with a mortality rate up to 29%. In addition, postoperative infections after sternotomy are associated with prolonged hospital stay, increased healthcare costs and impaired quality of patient life, representing an economic and social burden. The emergence of increasing antimicrobial resistant bacteria augments the importance of postsurgical infections since the antimicrobial choices are becoming limited. Furthermore, the incidence of infection is an indicator for the quality of patient care in the international benchmark studies. Although several therapy strategies are nowadays present in clinical practice, there is a lack of evidence-based surgical consensus for treatment of this surgical complication. In most cases the poststernotomy mediastinitis involves surgical revision with debridement, open dressing and/or vacuum-assisted therapy. After the granulation tissue on open chest wound is achieved, secondary closure and/or reconstruction with vascularized soft tissue flaps, such as omentum or pectoral muscle is performed. It seems there is a need for more effective surgical treatment of poststernotomy wound infections, which may address the prolonged hospitalization and reduce the number of surgical interventions and with this also the perioperative morbidity. In light of this we propose a randomized study comparing new delayed primary closure of the sternum to the secondary vacuum-assisted closure.

PDF

http://icvts.oxfordjournals.org/content/12/6/914.full.pdf+html

June 14, 2012 at 3:19 pm

Systemic antibiotic therapy for chronic osteomyelitis in adults.

Clin Infect Dis. 1 Feb 2012  V.54 N.3 P.393-407.

Spellberg B, Lipsky BA.

Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA 90502, USA. bspellberg@labiomed.org

Abstract

The standard recommendation for treating chronic osteomyelitis is 6 weeks of parenteral antibiotic therapy. However, oral antibiotics are available that achieve adequate levels in bone, and there are now more published studies of oral than parenteral antibiotic therapy for patients with chronic osteomyelitis. Oral and parenteral therapies achieve similar cure rates; however, oral therapy avoids risks associated with intravenous catheters and is generally less expensive, making it a reasonable choice for osteomyelitis caused by susceptible organisms. Addition of adjunctive rifampin to other antibiotics may improve cure rates. The optimal duration of therapy for chronic osteomyelitis remains uncertain. There is no evidence that antibiotic therapy for >4-6 weeks improves outcomes compared with shorter regimens. In view of concerns about encouraging antibiotic resistance to unnecessarily prolonged treatment, defining the optimal route and duration of antibiotic therapy and the role of surgical debridement in treating chronic osteomyelitis are important, unmet needs.

PDF

http://cid.oxfordjournals.org/content/54/3/393.full.pdf+html

 

June 14, 2012 at 3:16 pm


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