Title : Early osteoarticular material infections: Clinical, diagnostic, therapeutic and progressive features
Abstract:
Introduction :
Early osteoarticular material infection is becoming more common these days. It requires complex and multidisciplinary management. The objective is to study the clinical, diagnostic, and therapeutic particularities of early osteoarticular material infection.
Materials and methods:
A retrospective study including all patients who were hospitalized in the Infectious Diseases department for early osteoarticular material infection (according to the Coventry classification), between January 2021 and December 2022.
Results:
We collected 33 cases: 12 men and 21 women with a sex ratio of 0,57. The median age was 69,42 (26 - 84) years. Sixteen patients were diabetic (48,5%), fourteen patients were hypertensive (42,4%), and only one patient was suffering from hepatic cirrhosis (3%). Active smoking was noted in 3 cases (9%). The average time between the application of the osteosynthesis equipment and the appearance of infection signs was estimated to be 11,9 (1 - 26) days. The average consultation time was 3,5 (0-10) days. The most common clinical symptoms were pus draining from the surgical wound noted in 26 cases (78,8%), recurrence or sudden worsening of local pain noted in 25 cases (75,8%), persistence or onset of local inflammation signs noted in 28 cases (84,8%), absence and/or delayed cicatrization noted in 7 cases (21,2%) and presence of fistulae noted in 4 cases (12,1%). Fever was present in 12 cases (36,3%). 26 patients had biological inflammatory syndrome (78,7%). Blood cultures were positive in only 9 (37,5%) of 24 patients. All patients underwent surgical debridement and washout; 29 patients (87,8%) underwent drainage and 3 patients (9%) underwent infected material removal. Intraoperatively, frank pus was found in 19 cases (57,5%). Osteoarticular material infections were monomicrobial in 14 cases (42,4%). Staphylococcus aureus was isolated in 10 cases (30,3%), and Coagulasenegative staphylococci (Staphylococcus epidermidis in 3 cases) were isolated in 8 cases (24,2%). Gram-negative bacilli, either alone or associated with cocci, were isolated in 25 cases (75,7%). Probabilistic treatment with anti-microbial agents covering methicillin-resistant staphylococci and gram-negative bacilli was initiated in all cases, followed by adapted antibiotics. The mean duration of intravenous antibiotic therapy was 23,5 (5-46) days. The mean total duration of antibiotic therapy was 51,7 (35-98) days. The average length of hospital stay was 27,7 (7 - 65) days. The outcome was favorable in 51,5%, and only one case of death was noted (3%).
Conclusion :
The early osteoarticular material infection has become increasingly common and alarming. However, early warning signs should be identified as soon as possible to ensure early management and a better prognosis.
