Related Experiment Video
Updated: Jun 10, 2025
Visualization of Pseudomonas aeruginosa within the Sputum of Cystic Fibrosis Patients
Published on: July 16, 2020
Posttraumatic Pseudomonas aeruginosa Osteomyelitis in Mosul and Gaza: A Retrospective Cohort Study, 2018-2022
Ali Qasim Mohammad Taher1,2, Rasha Aqel3,4, Mohammed Alnajjar4,5
1Mosul Project, Iraq Mission, Operational Centre Brussels, Médecins Sans Frontières, Mosul City, Iraq.
Background:
The history of conflicts in the Middle East has resulted in a high burden of complications from conflict-related wounds like posttraumatic osteomyelitis (PTO). This is particularly challenging to manage in settings like Mosul, Iraq and Gaza, Palestine, where healthcare systems are weakened. In nonconflict settings, PTO caused by Pseudomonas aeruginosa (PAPTO) can lead to >20% of treatment failures. We aim to describe the clinical characteristics, outcomes, and management, in PAPTO patients admitted to Médecins Sans Frontières (MSF) facilities in Mosul and Gaza between 1 April 2018 and 31 January 2022.
Methods:
We conducted a retrospective cohort study on patients with PAPTO diagnosed with culture of intraoperative bone biopsy, using routinely collected data.
Results:
Among 66 PAPTO episodes from 61 enrolled patients, 37.9% had a multidrug-resistant Pseudomonas aeruginosa, with higher antibiotic resistance in Gaza. Polymicrobial infections were prevalent (74.2%), mainly involving Staphylococcus aureus (74.1%), being predominantly methicillin-resistant (95.0%). Overall, 81.7% received appropriate antibiotic treatment, with monotherapy used in 60.6% of episodes and a median treatment duration of 45.5 days. Recurrence was observed in 24.6% of episodes within a median of 195 days (interquartile range, 64-440 days). No significant differences were found in recurrence rates based on the type of antibiotic treatment (mono- or dual therapy) or episode (mono- or polymicrobial).
Conclusions:
Management of PAPTO in the conflict-affected, low-resource settings of Mosul and Gaza achieved a recurrence rate aligned with global reports through appropriate and targeted antibiotic use, primarily in monotherapy, provided over a mean treatment duration of 45.5 days.
Insights
Posttraumatic osteomyelitis (PTO) caused by Pseudomonas aeruginosa (PAPTO) in conflict zones like Mosul and Gaza showed high rates of multidrug resistance. Effective management with appropriate antibiotics, often monotherapy, achieved recurrence rates comparable to global averages.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Public Health in Conflict Zones
Background:
- Conflict in the Middle East leads to complex wounds and posttraumatic osteomyelitis (PTO).
- Managing PTO, especially from Pseudomonas aeruginosa (PAPTO), is difficult in resource-limited, conflict-affected areas like Mosul and Gaza.
- PAPTO contributes to over 20% of treatment failures in non-conflict settings.
Purpose of the Study:
- To describe the clinical characteristics of PAPTO patients.
- To analyze outcomes and management strategies for PAPTO in MSF facilities in Mosul and Gaza.
- To evaluate recurrence rates and factors influencing them.
Main Methods:
- Retrospective cohort study of PAPTO patients diagnosed via bone biopsy cultures.
- Data collected from Médecins Sans Frontières (MSF) facilities in Mosul and Gaza.
- Study period: April 2018 to January 2022.
Main Results:
- 37.9% of 66 PAPTO episodes involved multidrug-resistant Pseudomonas aeruginosa, with higher resistance in Gaza.
- Polymicrobial infections were common (74.2%), frequently including methicillin-resistant Staphylococcus aureus (95.0%).
- 81.7% received appropriate antibiotics, predominantly monotherapy (60.6%) for a median of 45.5 days; recurrence was 24.6% within 195 days.
Conclusions:
- Management of PAPTO in conflict zones achieved recurrence rates similar to global benchmarks.
- Appropriate and targeted antibiotic use, primarily monotherapy, is effective.
- A median treatment duration of 45.5 days was utilized.
