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Osteomyelitis attributable to vancomycin-resistant enterococci.

Paul D Holtom1, David Zamorano, Michael J Patzakis

  • 1Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA.

Clinical Orthopaedics and Related Research
|October 3, 2002
PubMed
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Vancomycin-resistant enterococcus (VRE) osteomyelitis is a growing concern in healthcare settings. This review highlights treatment outcomes for 10 patients, emphasizing surgical intervention and targeted antibiotics for VRE bone infections.

Area of Science:

  • Orthopaedic Surgery
  • Infectious Diseases
  • Microbiology

Background:

  • Vancomycin-resistant enterococcus (VRE) emerged in 1988 and is a significant cause of nosocomial infections.
  • VRE osteomyelitis presents a therapeutic challenge, particularly in patients with orthopaedic hardware or underlying conditions.
  • This study reviews cases of VRE osteomyelitis to understand its clinical presentation and treatment outcomes.

Purpose of the Study:

  • To retrospectively analyze 10 cases of vancomycin-resistant enterococcal osteomyelitis.
  • To evaluate treatment strategies, including surgical debridement and antibiotic regimens.
  • To assess patient outcomes and identify risk factors associated with VRE bone infections.

Main Methods:

  • Retrospective review of 10 patients diagnosed with vancomycin-resistant enterococcal osteomyelitis over a 2-year period.

Related Experiment Videos

  • Analysis of patient demographics, underlying medical conditions, and previous hospitalizations.
  • Review of treatment protocols, including surgical interventions and antibiotic choices (chloramphenicol, quinupristin/dalfopristin).

    • Main Results:

    • The 10 patients presented with diverse orthopaedic infections, including joint arthroplasty, tibial nail, external fixator, and femur osteomyelitis.
    • Eight patients had monomicrobial VRE infections; four had underlying illnesses, and four were intravenous drug users.
    • All patients initially responded to treatment (surgery and antibiotics), but one experienced recurrence and died from bacteremia.

    Conclusions:

    • Vancomycin-resistant enterococcal osteomyelitis, though potentially uncommon, requires aggressive management involving surgical debridement and appropriate antibiotics.
    • The increasing prevalence of VRE suggests it may become a more significant pathogen in orthopaedic infections.
    • Early identification and comprehensive treatment are crucial for improving outcomes in VRE osteomyelitis.