Surgical intervention for vertebral osteomyelitis in a calf

Microbiological aspects of osteomyelitis in veterinary medicine: drawing parallels to the infection in human medicine

Osteomyelitis is a challenging infectious disease affecting humans and animals. It is difficult to diagnose because, in many cases, symptoms are non-specific and, for example in implant-related cases, can appear long time after surgery. In addition to this, it is also difficult to treat due to the need to find the appropriate antibiotic regime and delivery system to reach the site of infection and to avoid development of bacterial resistance. The central purpose of this review is to compare the microbiological aspects of osteomyelitis in human and veterinary medicine, with the aim of improving the microbiological diagnosis and treatment of this infection in animals. Furthermore, the study of osteomyelitis in animals may help to improve the development of animal models for testing new treatments in humans. Host factors and underlying conditions have been studied mainly in humans, although aspects as immunodeficiency have been described in some veterinary cases. Even when Staphylococcus aureus is still considered the most prevalent causing microorganism, this prevalence should be reviewed using molecular diagnostic techniques, and this could affect treatment options. New approaches to treatment include local delivery of antibiotics using different biomaterials, antimicrobial photodynamic therapy, and new antimicrobial compounds. We would like to remark the need of large, high-quality clinical trials and of the development of guides for the diagnosis and treatment of osteomyelitis in different animal species.

Relationship Between Time to Surgical Debridement and the Incidence of Infection in Patients with Open Tibial Fractures

OBJECTIVE

To analyze the relationship between the length from injury to first debridement (LFITFD) of open tibial fractures and perioperative infection, and explore independent risk factors related to infection.

METHODS

This retrospective study focused on 215 clinical patients with open tibial fractures who were admitted from January 2012 to January 2017. According to the time from injury to the operation, the patients were categorized into four groups: LFITFD ≤ 6 h, 6 < LFITFD ≤ 12 h, 12 < LFITFD≤24 h, and (LFITFD > 24 h). Infection risk factors were screened by univariate analysis, and multivariate logistic regression analysis was used to determine independent risk factors.

RESULTS

The infection rates of four groups were 9.2%, 9.5%, 11.1%, and 10.5% with six of 65, nine of 95, four of 36, and two of 19 patients being infected, respectively. There was no statistical significance between the four groups. The infection rates among fractures of different Gustilo-Anderson classifications were as follows. Of 62 cases of type I fractures, two were infected, and the infection rate was 3.2%. Among those with type II fractures, eight were infected, and the infection rate was 8.2%. Three of 26 cases of type IIIA fracture were infected, yielding an infection rate of 11.5%, seven of 25 cases of type III B fracture were infected (28% infection rate), and one of four cases of type III C fracture was infected (25% infection rate). There was a statistically significant difference between the five groups. Multivariate regression analysis showed that smoking, combined diabetes, surgical time, and fracture Gustilo-Anderson classification were independent risk factors for perioperative infection of open tibial fractures, and the difference in time from injury to first debridement was not related to infection.

CONCLUSION

The incidence of perioperative infection in patients with open tibial fractures has little to do with the time of the first debridement, which is mainly related to the level of the fracture's Gustilo-Anderson classification. At the same time, smoking is prohibited before the operation, the patient's blood glucose is managed, and the debridement operation time is minimized conducive to reducing the incidence of infection.