Limited internal fixation combined with a hinged external fixator in treatment of peri-elbow bone infection / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the effectiveness of limited internal fixation combined with a hinged external fixator in the treatment of peri-elbow bone infection.@*METHODS@#The clinical data of 19 patients with peri-elbow bone infection treated with limited internal fixation combined with a hinged external fixator between May 2018 and May 2021 were retrospectively analyzed. There were 15 males and 4 females with an average age of 44.6 years (range, 28-61 years). There were 13 cases of distal humerus fractures and 6 cases of proximal ulna fractures. All the 19 cases were infected after internal fixation of fracture, and 2 cases were complicated with radial nerve injury. According to Cierny-Mader anatomical classification, 11 cases were type Ⅱ, 6 cases were type Ⅲ, and 2 cases were type Ⅳ. The duration of bone infection was 1-3 years. After primary debridement, the bone defect was (3.04±0.28) cm, and the antibiotic bone cement was implanted into the defect area, and the external fixator was installed; 3 cases were repaired with latissimus dorsi myocutaneous flap, and 2 cases were repaired with lateral brachial fascial flap. Bone defects repair and reconstruction were performed after 6-8 weeks of infection control. The wound healing was observed, and white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) were reexamined regularly after operation to evaluate the infection control. X-ray films of the affected limb were taken regularly after operation to observe the bone healing in the defect area. At last follow-up, the flexion and extension range of motion and the total range of motion of the elbow joint were observed and recorded, and compared with those before operation, and the function of the elbow joint was evaluated by Mayo score.@*RESULTS@#All patients were followed up 12-34 months (mean, 26.2 months). The wounds healed in 5 cases after skin flap repair. Two cases of recurrent infection were effectively controlled by debridement again and replacement of antibiotic bone cement. The infection control rate was 89.47% (17/19) in the first stage. Two patients with radial nerve injury had poor muscle strength of the affected limb, and the muscle strength of the affected limb recovered from grade Ⅲ to about grade Ⅳ after rehabilitation exercise. During the follow-up period, there was no complication such as incision ulceration, exudation, bone nonunion, infection recurrence, or infection in the bone harvesting area. Bone healing time ranged from 16 to 37 weeks, with an average of 24.2 weeks. WBC, ESR, CRP, PCT, and elbow flexion, extension, and total range of motions significantly improved at last follow-up ( P<0.05). According to Mayo elbow scoring system, the results were excellent in 14 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 89.47%.@*CONCLUSION@#Limited internal fixation combined with a hinged external fixator in the treatment of the peri-elbow bone infection can effectively control infection and restore the function of the elbow joint.

Staged treatment of chronic hematogenous osteomyelitis of long bone by induced membrane technique in adults / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of induced membrane technique in the staged treatment of adult chronic hematogenous osteomyelitis (CHOM) of long bone.Methods:The clinical data were retrospectively analyzed of the 22 adult patients with CHOM of long bone who had been admitted to the 920th Hospital, Joint Logistics Support Force of PLA from January 2016 to December 2019. There were 18 males and 4 females, aged from 16 to 56 years (average, 31.81 years). Their disease duration ranged from 0.6 to 42.0 years, averaging 18.4 years. By the Cierny-Mader anatomical classification, 4 cases were type Ⅰ, 6 cases Type Ⅲ, and 12 cases type Ⅳ. In the first stage, the bone defects were filled with antibiotic bone cement after thorough debridement. In the second stage when the infection had been controlled, the bone defects were repaired with bone grafts after removal of the bone cement. Bone healing time and complications were followed up. The treatment effects were evaluated by comparisons of the infection control indexes [including clinical manifestations like local redness, swelling, pus, and pain, and blood white blood cell count, C-Reactive protein (CRP), and erythrocyte sedimentation rate (ESR) as well] before the primary surgery, before the secondary surgery and at the last follow-up.Results:The volumes of the bone defects after stage-one debridement ranged from 54 cm 3 to 176 cm 3 (mean, 90.9 cm 3). All patients were followed up for 20 to 51 months (mean, 30.1 months) after surgery. All bone defects healed after 4 to 11 months (mean, 6.6 months). Postoperatively, infection developed at the bone extraction site of the posterior superior iliac spine in 3 cases and pain was observed at the donor site in one case, but the conditions were relieved after symptomatic treatment. Fracture and plate breakage occurred at the bone defect site in one case who had fallen down 7 months after operation, but responded to reoperation. The last follow-up revealed such symptoms as redness, swelling and pus discharge in none of the patients. The white blood cell count [(5.70 ± 1.57) × 10 9/L and (5.65 ± 1.58) × 10 9/L], CRP [(7.56 ± 2.57) mg/L and (7.25 ± 3.83) mg/L] and ESR [(9.64 ± 2.90) mm/h and (10.55 ± 5.23) mm/h] before the secondary surgery and at the last follow-up were significantly lower than those before the primary surgery [(8.24 ± 2.18) × 10 9/L, (49.54 ± 19.56) mg/L, and (42.68 ± 13.77) mm/h] (all P < 0.05). However, there were no significant differences between the indexes before the secondary surgery and at the last follow-up ( P > 0.05). Conclusion:In the staged treatment of adult CHOM of long bone, the induced membrane technique can effectively control infection, achieve repair of bone defects, and reduce complications.

Use of bedaquiline in spinal osteomyelitis and soft tissue abscess caused by multidrug-resistant Mycobacterium tuberculosis: A case report

Abstract Introduction Spinal Tuberculosis (STB) represents between 1% and 2% of total tuberculosis cases. STB management remains challenging; the first-line approach consists of medical treatment, while surgery is reserved for patients with complications. No data regarding STB treatment with bedaquiline-containing regimens are available in the literature. Case description Herein, we report the case of a 21-year-old man from Côte d'Ivoire with a multidrug resistance STB with subcutaneous abscess. After approval of the hospital off-label drug committee, we started bedaquiline 400 mg daily for two weeks, followed by 200 mg three times per week, for 22 weeks, associated with linezolid 600 mg daily, rifabutin 450 mg daily, and amikacin 750 mg daily (interrupted after eight weeks). During treatment, we performed a weekly EKG. No QT prolongation was shown, but inverted T waves appeared, requiring several cardiological consultations and cardiac MRI, but no cardiac dysfunction was found. After 24 weeks, bedaquiline was replaced with moxifloxacin 400 mg daily. The patient continued treatment for another year. We performed another computer tomography at the end of treatment, confirming the cure. Discussion A salvage regimen containing bedaquiline proved effective in treating multidrug-resistance tuberculosis spinal infection without causing severe adverse effects. However, further studies are needed to evaluate better bedaquiline bone penetration and the correct duration of treatment with bedaquiline in MDR spinal tuberculosis.

Current opinions on the mechanism, classification, imaging diagnosis and treatment of post-traumatic osteomyelitis / 中华创伤杂志(英文版)

Post-traumatic osteomyelitis (PTO) is a worldwide problem in the field of orthopaedic trauma. So far, there is no ideal treatment or consensus-based gold standard for its management. This paper reviews the representative literature focusing on PTO, mainly from the following four aspects: (1) the pathophysiological mechanism of PTO and the interaction mechanism between bacteria and the body, including fracture stress, different components of internal fixation devices, immune response, occurrence and development mechanisms of inflammation in PTO, as well as the occurrence and development mechanisms of PTO in skeletal system; (2) clinical classification, mainly the etiological classification, histological classification, anatomical classification and the newly proposed new classifications (a brief analysis of their scope and limitations); (3) imaging diagnosis, including non-invasive examination and invasive examination (this paper discusses their advantages and disadvantages respectively, and briefly compares the sensitivity and effectiveness of the current examinations); and (4) strategies, including antibiotic administration, surgical choices and other treatment programs. Based on the above-mentioned four aspects, we try to put forward some noteworthy sections, in order to make the existing opinions more specific.

Evaluation of the Treatment of Patients Subjected to Osteogenesis Induced by Tibia Bone Distraction / Avaliação do tratamento de pacientes submetidos a osteogênese por distração na tíbia

Abstract Objectives To evaluate the management of tibial fractures resulting in bone loss (traumatic or infection-related) and the complications occurring during treatment with external fixator and immediately after apparatus removal. Methods Forty patients were selected from 2010 to 2017. The mean age of the patients was 33.02 years; 34 subjects were male and 6 were female. All patients had tibial bone regeneration, suffered trauma (mainly related to motorcycle accident) and were followed-up at an outpatient facility. Results Proximal tibial bones of up to 17 cm in length and distal tibial bones of up to 14 cm in length were obtained. The largest trifocal transport had the same length as the regenerated bone tissues, which was 14.5 cm. Regarding complications, 29 (72.5%) patients had infections in the pin and wire paths. There were 9 (22.5%) cases of de novo fracture, 6 of which were managed with the implantation of a new circular fixator, and 2 cases of infection of the regenerated bone. On average, patients were subjected to 4.72 procedures (ranging from 2-12), had the fixator for 20.75 months (ranging from 7-55 months), and stayed at the hospital for 53.7 days (ranging from 5-183 days), mainly because of soft-tissue complications, intravenous antibacterial therapy, and even social issues. Two (5%) patients presented symptomatic gonarthrosis, and two other patients had symptomatic ankle arthritis. Three of the patients showed lower limb discrepancy of 3.0, 3.7, and 5.0 cm. Conclusion Despite not being widely available, the Ilizarov method is useful for solving the majority of tibial bone losses, regardless of their etiology.

Resumo Objetivo Avaliar o tratamento das fraturas de tíbia que evoluíram com perda óssea (traumática ou secundária a infecção) e as complicações ocorridas durante o tratamento com fixador externo e no período imediatamente após sua retirada. Métodos Foram selecionados 40 pacientes tratados entre 2010 e 2017, com a idade média de 33,02 anos, sendo 34 do sexo masculino e 6 do sexo feminino. Todos os pacientes portavam regenerado ósseo da tíbia, foram vítimas de trauma (sobretudo motociclístico), e estavam em seguimento ambulatorial. Resultados Foram obtidos regenerados ósseos da tíbia proximal de até 17 cm e da tíbia distal de 14 cm. O maior transporte trifocal teve a soma do tamanho dos tecidos dos ossos regenerados, medindo 14,5 cm. Como complicações, 29 (72,5%) pacientes tiveram infecção no trajeto dos pinos e fios. Houve 9 (22,5%) casos de refratura, sendo 6 deles tratadas com novo fixador circular, e 2 infecções no osso regenerado. Os pacientes foram submetidos a uma média de 4,72 procedimentos cirúrgicos (2-12), portaram fixador por 20,75 meses (7-55 m.) e permaneceram internados por 53,7 dias (5-183) devido principalmente a complicações de partes moles, a antibioticoterapia intravenosa ou até mesmo a questões sociais. Dois (5%) pacientes apresentaram gonartrose sintomática e outros 2 artrite sintomática do tornozelo. Três apresentaram discrepância de membros inferiores de 3,0; 3,7; e 5,0 cm. Conclusão Apesar de não ser um método de tratamento amplamente disponível, o método de Ilizarov é útil para solucionar a maioria das falhas ósseas da tíbia, independente da sua etiologia.

Research progress in constructing animal models of staphylococcus aureus-associated osteomyelitis / 中国组织工程研究

BACKGROUND: Staphylococcus aureus has become the most important pathogen of osteomyelitis In the world. An excellent and standard homogenous animal model plays an Important role regarding the Infectious mechanism of osteomyelitis, the acquisition of new preventive and therapeutic measures, and the application of new technologies in clinical practice. OBJECTIVE: To review the research progress and problems in the construction of animal models of Staphylococcus aureus-associated osteomyelitis at home and abroad. METHODS: A computer-based search of CNKI, PubMed, MEDLINE, Embase, and Cochrane was performed for relevant articles concerning the experimental osteomyelitis model, including review, basic research and clinical research, published from January 2010 to June 2019. The keywords were "Staphylococcus aureus; bone Infection; osteomyelitis; Implant-associated osteomyelitis; bone defect osteomyelitis; fracture osteomyelitis; biofilm; experimental osteomyelitis model" in Chinese and English, respectively. After Initial screening of titles and abstracts and exclusion of irrelevant articles, 45 eligible articles were Included In final analysis. RESULTS AND CONCLUSION: Construction of an osteomyelitis animal model is related to many factors. Although researchers from various countries have continuously Improved and gradually quantified the Infection process In recent years, a unified standard has not yet been developed. To date, there is no single microbiology or Imaging method to determine bone Infection. In animal models of acute osteomyelitis, the use of microbiological tests such as nuc RTQ-PCR and bioluminescence tomography can dynamically monitor and quantify the bone Infection process at an early stage. In the animal model of chronic osteomyelitis, we can dynamically observe the process of osteolysis and bone remodeling based on the micro-CT and MRI images. Advanced Imaging technologies such as18F-FDG PET/CT can be used to confirm or exclude chronic osteomyelitis with high diagnostic accuracy. The use of animal models of osteomyelitis contributes to standardizing the number and activity of infected bacteria during early diagnosis and quantified treatment, which Is the direction for further research.

New perspectives on traumatic bone infections / 中华创伤杂志(英文版)

In this paper, we review the results of previous studies and summarize the effects of various factors on the regulation of bone metabolism in traumatic bone infections. Infection-related bone destruction incorporates pathogens and iatrogenic factors in the process of bone resorption dominated by the skeletal and immune systems. The development of bone immunology has established a bridge of communication between the skeletal system and the immune system. Exploring the effects of pathogens, skeletal systems, immune systems, and antibacterials on bone repair in infectious conditions can help improve the treatment of these diseases.

Cervical vertebral osteomyelitis secondary to Streptococcus equi infection in an adult horse - case report / Osteomielite vertebral cervical secundária à infecção por Streptococcus equi em um cavalo adulto - relato de caso

A 15-year-old, mixed breed, male horse was attended with a history of multiple abscesses in the cervical region with a three-year evolution. Upon admission, three fistulous tracts with drainage of purulent secretions in the cervical region, low body score, restriction of cervical movements, and painful sensitivity to palpation were observed. The horse was diagnosed with osteomyelitis secondary to Streptococcus equi infection. The initial treatment was antibiotic therapy and local curative. Owing to the lack of response, surgical debridement was performed. An initial favorable response was observed; however, after 4 months, drainage recurred, and the animal was euthanized. A post-mortem computed tomography scan was performed to obtain details of the injury. Cervical osteomyelitis is rare, and its occurrence through hematogenous spread in adult horses and the tomographic findings had not been reported previously. The long period of evolution, difficulty in performing an aggressive debridement, and the presence of multi-drug resistant bacteria contributed to the negative outcome.(AU)

Um equino macho, sem raça definida, de 15 anos de idade, foi atendido com histórico de múltiplos abscessos cervicais com evolução de três anos. Na admissão, foram observados: três trajetos fistulosos com drenagem de material purulento na região cervical; baixo escore corporal; restrição de movimentos cervicais; e sensibilidade dolorosa à palpação da região. Foi diagnosticada osteomielite vertebral cervical secundária à infecção por Streptococcus equi. O tratamento inicial consistiu na administração de antibióticos e curativo local. Na ausência de resposta à terapia, realizou-se o debridamento cirúrgico. Inicialmente, obteve-se uma resposta favorável, entretanto, após quatro meses, houve recidiva da lesão e o animal foi submetido à eutanásia. Realizou-se tomografia computadorizada no post mortem para detalhamento da lesão. A osteomielite vertebral cervical é rara, e sua ocorrência por meio de disseminação hematógena em animais adultos não foi previamente reportada. O longo período de evolução, aliado à dificuldade de realização de um debridamento agressivo, e a característica multirresistente do agente etiológico contribuíram para o desfecho negativo do caso.(AU)

Osteomielitis Aguda: Características Clínicas, Radiológicas y de Laboratorio / Acute Osteomyelitis: Clinical, Radiological and Laboratory Characteristics

Resumen Se efectuó una revisión de la literatura sobre ésta patología incapacitante y frustrante, tanto para el paciente como el médico tratante, ya que sus manifestaciones clínicas son similares a otros cuadros infecciosos. Además, se exponen conceptos acerca de su definición, clasificación y etiología, para actualizar de manera breve el proceso infeccioso. Los estudios por imágenes proveen información adicional ante la sospecha clínica; pero ninguna técnica puede confirmar o excluir en forma absoluta la presencia de osteomielitis, especialmente cuando existen implantes u osteopatía. Se debe evaluar minuciosamente la elección de cada uno de estos métodos, teniendo en cuenta su disponibilidad y qué se pretende hacer con ellos. Nunca debe postergarse la realización de procedimientos invasivos, que en general son necesarios para arribar al diagnóstico. El principal objetivo es indagar dentro de los distintas prácticas diagnósticas, para que de ésta manera el equipo médico utilice herramientas adecuadas para determinar si se trata de ésta afección en los distintos centros de trabajo y así utilizar de manera eficaz los recurso disponibles en cada nivel de atención; brindando así un tratamiento precoz y evitar las complicaciones pertinentes a corto y a largo plazo.

Abstract Osteomylitis is a painful and incapacitating disease which is frustrating for the patient and for the doctor treating it. Its symptoms are very similar to other types of infections. The definition, classification and etiology will be briefly explained in order to provide a better understanding about this infectious disease. Medical Imaging Procedures provide aditional information when the presence of the disease is suspected. There is not a certain technique that can confirm or exclude its existence, especially when implants or osteopathy have taken place. Any choice of method must be minutely assessed, keeping in mind its availability and what you expect from it. The invasive procedures should never be postponed, due to the importance they have when getting a diagnosis. The main objective is to look into different diagnoses, so the medical team can have the appropriate tools to determine the presence of the illness in a working area. Using the tools in an efficient way and taking advantage of the resources available, can provide preventive and early treatment in order to avoid short and long term complications.

Treatment of infective long bone defect by external fixator combination of iliac bone graft with deep iliac circumflex vessels / 中华显微外科杂志

Objective To discuss the technique and clinical effect of infective long bone defect treated by external fixator combination of iliac bone graft with deep iliac circumflex vessels.Methods All 28 patients with posttraumatic infective long bone defect were treated by external fixator and iliac bone graft with deep iliac circumflex vessels from July, 2008 to June, 2014.The length of the bone defect was from 3 to 7 cm (averaged 5.1 cm), including tibia defect in 13 patients, femoral defect in 7, humeral defect in 4, and ulna and radius defect respectively in 2, and 17 patients also with soft tissue defect.After thorough debridement, the bone defect was fixed by the external fixator, and then VSD was applied for irrigation drainage.As fresh granulation tissue growth, iliac bone vascularized by deep iliac circumflex vessels, size from size 5.0 cm× 3.0 cm to 8.0 cm× 3.5 cm, was transplanted.As for composite defect of infective bone and soft tissue in 17 patients, 6 cases of them was repaired with the iliac flap combined free flap, three with the iliac flap combined local skin flap, 4 cases with the iliac flap doubled with both the deep and the shallow iliac circumflex vessels, 3 cases with the circumflex iliac artery chimeric perforators flap and 1 with random iliac osteocutaneous flap.Affected limb function was graded with Enneking's system.Results All transplanted vascularized iliac bone survived, postoperative infection controlled well, but there were 2 patients of iliac flap partial necrosis.After dressing exchange and reoperation, the wound all repaired again.Twenty-six patients followed from 8 to 50 months, with an average of 18 months while 2 patients lost postoperative.The osseous healing time of the iliac bone graft was an average of 6.5 months, 25 patients healed well but 1 case encouraged tibia fracture again.Appearance of the limb also recovered satisfactorily.Twenty-six patients had the average limb function restored in 89.7％.There was no obvious complication in the donor.Conclusion It is an effective technical method to treat infective long bone defect by external fixator combination of iliac bone graft with deep iliac circumflex vessels, which can not only fix and bridge bone defects and enhance bone healing, but also obliterate dead space and resist local infection by ensuring blood supply.But the method is suitable for the receipt site infection under control and the length of the long bone defect less than 10 cm.

Osteomyelitis: A Descriptive Study

BACKGROUND: To analyze the incidence and clinical-microbiological characteristics of osteomyelitis (OM) in a tertiary Spanish hospital. METHODS: All cases diagnosed with OM between January 2007 and December 2010 were retrospectively reviewed. The variables examined include epidemiological characteristics, risk factors, affected bone, radiographic changes, histology, microbiological culture results, antibiotic treatment, and the need for surgery. RESULTS: Sixty-three cases of OM were diagnosed. Twenty-six patients (41.3%) had acute OM whereas 37 patients (58.7%) were classified as chronic OM. OM may result from haematogenous or contiguous microbial seeding. In this group, 49 patients (77.8%) presented with OM secondary to a contiguous source of infection and 14 patients had hematogenous OM (22.2%). Staphylococcus aureus was the most commonly found microorganism. CONCLUSIONS: OM mainly affected patients with risk factors related to the presence of vascular diseases. Antibiotic treatment must be guided by susceptibility patterns of individual microorganisms, although it must be performed together with surgery in most of the cases.

Bacterial distribution in secretions of post-traumatic patients with infections and the drug treatment / 中国药学杂志

OBJECTIVE: To analyze the bacterial distribution of secretions in post-traumatic cases with bone infections and summarize the drug treatments in practice, thus to provide reference for treatment of bone infections. METHODS: The clinical data of traumatic patients with positive secretion cultures were collected from January to October in 2012. RESULTS: Eighty-one cases of positive secretion cultures were selected, of whom 57 (70.37%) patients had single bacteria infection, 24 (29.62%) cases had mixed infections. Staphylococcus aureus, coagulase-negative staphylococci, enterobacter cloacae, escherichia coli and pseudomonas aeruginosa were common pathogens. All the patients underwent surgical treatment and intravenous antibiotic therapy during hospitalization. Nineteen cases were implanted with antibiotic bone cement and 2 cases received local lavation. CONCLUSION: Post-traumatic bone infections are mostly caused by single bacteria and Gram-positive bacteria. Topical antibiotic bone cement treatment has become an effective treatment for bone infections.

Drug release characteristics of gatifloxacin-poly sebacic anhydride local controlled release system / 中国组织工程研究

BACKGROUND:High-dose antibiotics for bone infection have many adverse reactions, and its outcomes are not perfect. Thus, to explore a degradable material as a vector to prevent bone infection is valuable. OBJECTIVE:To study drug release characteristics of gatifloxa-poly sebacic anhydride local control ed release system in vivo. METHODS:A 3 mm × 6 mm bone window was made at right knee joint of New Zealand rabbits. The gatifloxacin-poly sebacic anhydride sustained release preparation was implanted. Heart blood, bone tissue and myeloid tissue specimens were obtained at 1, 2, 3, 6, 9, 12, 15, 18, 25 and 30 days after surgery. High-performance liquid chromatography was utilized to determine gatifloxacin concentration. Scanning electron microscope was employed to observe the structural changes before and after implantation of gatifloxacin-poly sebacic anhydride sustained release preparation. RESULTS AND CONCLUSION:After implantation of gatifloxacin-poly sebacic anhydride sustained release preparation, drug concentration gradual y decreased in the myeloid tissue, peaked at 1 day, stabilized at 3-15 days, gradual y reduced at 15-30 days. However, the drug concentration was stil higher than the minimal inhibitory concentration 0.1 mg/L against Staphylococcus aureus at 30 days. The peak of drug concentration in the bone tissue occurred at 3 days, and stabilized at other days, which was higher than 0.1 mg/L. At the same time point, drug concentration in the blood specimen was lower than that in the myeloid tissue and bone tissue. The degradation of gatifloxacin-poly sebacic anhydride sustained release preparation was surface erosion, and the shape of the degradation residue is smal globular. The change of the internal structure of gatifloxacin-poly sebacic anhydride sustained release preparation was not found. In the drug release procedure, gatifloxacin-poly sebacic anhydride sustained release preparation did not show disintegration or fragmentation. These results indicated that gatifloxacin-poly sebacic anhydride local sustained release preparation has good abilities of drug load and drug release.

Advances in the research of carrier materials for implant drug delivery system within bone / 国际生物医学工程杂志

Implant drug delivery system(IDDS) is helpful to the therapy of infection、tuberculosis and tumor of bone. With the development of tissue engineering, various materials has been used as the carriers for the IDDS. Research of the carrier materials used in implant drug delivery system is reviewed in this article.

The Usefulness of Oral Rifampin as Switch Therapy for the Soft Tissue and Bone Infections Caused by Methicillin-Resistant Staphylococcus aureus

BACKGROUND: Rifampin is sometimes used in combination with other anti-staphylococcal agents to treat methicillin-resistant Staphylococcus aureus (MRSA) infections but few reports are available about the usefulness of rifampin against MRSA infections, especially in soft tissue and bone infections. Thus, we evaluated the efficacy of rifampin as switch therapy for soft tissue and bone infections caused by MRSA and assessed the risk factors for treatment failure. MATERIALS AND METHODS: We retrospectively studied 44 patients who had soft tissue and bone infections caused by MRSA and were treated with rifampin in combination or as monotherapy as switch therapy from January 2001 to September 2004. RESULTS: The mean age of the subjects was 50.2 years and the number of male and female were 34 and 10, respectively. Median duration of rifampin use was 32 days and 25% of the patients had artificial prostheses. Thirty one patients (79.5%, 31/39) were cured with parenteral glycopeptide followed by rifampin in combination or as monotherapy. Eight patients (8/39) recurred after the completion of treatment. The presence of hip prosthesis was the only significant risk factor (P= 0.027) in multivariate logistic regression test. Rifampin was tolerable in all cases. CONCLUSION: Rifampin as switch therapy for soft tissue and bone infection caused by MRSA was effective in 79.5% (31/39) of sujects. The treatment failure seems to be associated with unremovable infected prosthesis.

The Usefulness of Oral Rifampin as Switch Therapy for the Soft Tissue and Bone Infections Caused by Methicillin-Resistant Staphylococcus aureus

BACKGROUND: Rifampin is sometimes used in combination with other anti-staphylococcal agents to treat methicillin-resistant Staphylococcus aureus (MRSA) infections but few reports are available about the usefulness of rifampin against MRSA infections, especially in soft tissue and bone infections. Thus, we evaluated the efficacy of rifampin as switch therapy for soft tissue and bone infections caused by MRSA and assessed the risk factors for treatment failure. MATERIALS AND METHODS: We retrospectively studied 44 patients who had soft tissue and bone infections caused by MRSA and were treated with rifampin in combination or as monotherapy as switch therapy from January 2001 to September 2004. RESULTS: The mean age of the subjects was 50.2 years and the number of male and female were 34 and 10, respectively. Median duration of rifampin use was 32 days and 25% of the patients had artificial prostheses. Thirty one patients (79.5%, 31/39) were cured with parenteral glycopeptide followed by rifampin in combination or as monotherapy. Eight patients (8/39) recurred after the completion of treatment. The presence of hip prosthesis was the only significant risk factor (P= 0.027) in multivariate logistic regression test. Rifampin was tolerable in all cases. CONCLUSION: Rifampin as switch therapy for soft tissue and bone infection caused by MRSA was effective in 79.5% (31/39) of sujects. The treatment failure seems to be associated with unremovable infected prosthesis.