Abstract
Study design
Retrospective cohort study.
Objectives
To analyze characteristics and treatment of osteomyelitis (OM) in the treatment of grade IV pressure injury (PI) in patients with spinal cord injury/disorder (SCI/D) following the Basel Decubitus Concept.
Setting
Acute care and rehabilitation clinic specialized in SCI/D.
Methods
Patients with SCI/D were admitted for grade IV PI treatment between 1st January 2010 and 28th February 2015. Patients, SCI/D, and PI characteristics were collected from chart reviews. Descriptive statistics and differences between groups with and without OM were evaluated.
Results
In total, 117 patients (87 male, 30 female) with 130 PI grade IV were included. In 95 patients (81%), OM was diagnosed histologically. In 87 cases, more than one bacterial species was involved. Out of 49 different bacterial species, Enterococcus faecalis and Staphylococus aureus were most frequently observed. Amoxicillin/clavulanic acid and ciprofloxacin were the most frequently used out of 24 different antibiotics. Length of antibiotic treatment varied between <8 days and >91 days with 31 patients receiving antibiotics for about 8 weeks. Complications occurred in all groups of antibiotic duration. Having a paraplegia, no OM and sacral PI was associated with increased complication rates, but the number of patients did not allow comprehensive risk factor analysis.
Conclusion
Because the variety of patients concerning SCI/D, PI, and OM characteristics did not show a conclusive relation between length of antibiotic treatment and complication rates, the development of a subgroup specific treatment concept for PI in patients with SCI/D would be favorable to further optimize antibiotic treatment.
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Data availability
All data are stored with the corresponding author and can be asked directly (anke.scheel-sailer@paraplegie.ch).
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Acknowledgements
We acknowledge the Decu Care Team (Karin Gläsche, Jessica Decker, Rita Müller, Zamzow) as the supported data collection and discussions in relation to clinical implementation of the results.
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JR developed the study, collected the data, wrote the paper and finalized the paper. RO, SB, MB, DJS, MV, RW were involved in creating the study, gave relevant feedback for the paper and approved the final version of the paper. JK and CF approved the study method, performed the statistical analyses, and gave valuable feedback regarding the paper. ASS developed the study, wrote the paper, and finalized the paper.
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Competing interests
The authors declare no competing interests with respect to this research, authorship, and publication of this paper. The work was a part of JE’s doctoral thesis (Dr med. Promotion).
Ethics approval
This study was conducted in compliance with the protocol, the current version of the Declaration of Helsinki, the ICH-GCP as well as all national legal and regulatory requirements, and excluded patients who denied their consent of further use of their data. All data were kept confidential and processed anonymously. The study received ethical permission from the Ethics Committee Northwest and Central Switzerland (EKNZ 2014-107). The RECORD checklist was applied in this observational study [33].
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41393_2022_758_MOESM1_ESM.docx
Characteristics of patients with spinal cord injury/ disorder (N=117) and grade IV pressure injury (N=137) after surgical treatment (N=125)
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Rigazzi, J., Fähndrich, C., Osinga, R. et al. Osteomyelitis and antibiotic treatment in patients with grade IV pressure injury and spinal cord lesion—a retrospective cohort study. Spinal Cord 60, 540–547 (2022). https://doi.org/10.1038/s41393-022-00758-1
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DOI: https://doi.org/10.1038/s41393-022-00758-1
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