Short Antibiotic Treatment Duration for Osteomyelitis Complicating Pressure Ulcers: A Quasi-experimental Study

Background

Osteomyelitis-complicating pressure ulcers are frequent among patients with spinal cord injuries (SCIs), and the optimal management is unknown. In our referral center, the current management is debridement and flap coverage surgeries, followed by a short antibiotic treatment. We aimed to evaluate patients' outcomes a year after surgery.

Methods

We performed a quasi-experimental retrospective before/after study on SCI patients with presumed osteomyelitis associated with perineal pressure ulcers. We included all patients who underwent surgery with debridement and flap covering, followed by effective antibiotic treatment, between May 1, 2016, and October 30, 2020. The effective antimicrobial treatment duration included the 10 days leading up to January 1, 2018 (before period), and the 5 to 7 days after (after period). We also compared the efficacy of 5-7-day vs 10-day antibiotic treatment and performed uni- and multivariable analyses to identify factors associated with failure.

Results

Overall, 415 patients were included (77.6% male patients; mean age ± SD, 53.0 ± 14.4 years). Multidrug-resistant organisms (MDROs) were involved in 20.7% of cases. Favorable outcomes were recorded in 69.2% of cases: 117/179 (65.3%) in the 10-day treatment group vs 169/287 (71.9%) in the 5-7-day treatment group (P = .153). The only factor associated with failure in the multivariate analysis was a positive culture from suction drainage (odds ratio, 1.622; 95% CI, 1.005-2.617; P = .046). Effective treatment duration >7 days and intraoperative samples negative for MDROs were not associated with better outcomes (P = .153 and P = .241, respectively).

Conclusions

A treatment strategy combining surgical debridement and flap covering, followed by 5 to 7 days of effective antibiotic treatment seems safe.

Management of urethrocutaneous fistulae complicating sacral and perineal pressure ulcer in neurourological patients: A national multicenter study from the French-speaking Neuro-urology Study Group and the Neuro-urology committee of the French Association of Urology

PURPOSE

To describe the epidemiologic characteristics of urethrocutaneous fistulae (UCF) in sacro-perineal pressure ulcer (SPPU) in neurourological patients and to assess outcomes after surgical urinary diversion.

MATERIALS AND METHODS

Through the French-speaking Neurourology Study Group and Association of Urology network, a retrospective multicenter study in nine major urology and physical medicine and rehabilitation (PMR) units was conducted. All patients with SPPU associated with UCF between 2000 and 2016 were included. Data concerning: sociodemography, clinical, medical and biological comorbidities, neurological and urological history, pressure ulcer characteristics, and finally urinary diversion surgery were collected. Complications and SPPU healing/relapse were assessed.

RESULTS

In all, 74 patients were included. The median age on diagnosis: 45.9 years (interquartile range [IQR], 38.7-53.4) and median follow-up: 15.1 months (IQR, 5.7-48.8). A psychiatric disorder was the most frequent comorbidity (44.6%). Only 59.5% and 50% had regular PMR and urologic follow-up, respectively. Seventy-one patients (95.9%) underwent urinary diversion surgery. Among those, relapse occurred in 15 (21.1%) at the end of the follow-up. The diversion was noncontinent in 85.9%. The major complications rate was 26.8%. A total of 30 late complications in 21 patients were reported. The most frequent was obstructive pyelonephritis (n = 9). All of the patients who underwent surgical diversion without cystectomy (n = 5) developed a pyocyst. Finally, the pressure ulcer healing rate when patients underwent both urinary diversion and pressure ulcer surgery was 74.4%.

CONCLUSIONS

Our retrospective data suggest that UCF complicating SPPU is a rare and severe pathology. The combination of radical urinary diversion with cystectomy and pressure ulcer surgery should be performed as often as possible.

[Merkel cell carcinoma: study of 24 cases and review of the literature]

Merkel cell carcinoma is a cutaneous-neuroendocrine tumor, which may be difficult to diagnose and to treat.

OBJECTIVE

The objective of this study was to analyse the treatment and the recurrences of Merkel cell carcinoma.

PATIENTS AND METHODS

A retrospective study was performed on the patients operated of a Merkel cell carcinoma between 1994 and 2004. Clinical data of the patients and the tumor, treatment (surgery and radiotherapy) and recurrences were entered in a database.

RESULTS

Twenty-four patients were operated (8 men and 16 women). The mean age at diagnosis was 71.5 years. The average follow-up was 30.8 months. The treatment was a large surgical removal of the tumor with immediate closure, systematically followed by radiotherapy. There were five recurrences and no death.

CONCLUSION

Merkel cell carcinoma is an aggressive tumor. Immediate closure after large surgical removal allows radiotherapy.

Management of advanced and recurrent squamous cell carcinoma of the inner nasal lining

Ten cases of advanced and eight cases of recurrent carcinomas of the inner nasal lining were managed in our department between June 1996 and June 2003. Six tumours were managed by operation alone, four by a combination of operation and radiotherapy, two by a combination of chemotherapy and operation, and five by a combination of chemotherapy, operation and radiotherapy. One patient died before the end of treatment. One patient had a combination of chemotherapy and radiotherapy. Eleven patients had reconstructions.

RESULTS

After a mean follow up of 2.7 years (range: 3 months to 7 years), 15 patients were disease-free. Two patients had died of their disease, and one had died of an unrelated cause. Reconstruction was satisfactory in six of the eight cases that were evaluated. Prostheses were satisfactory in four of six cases.