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Multicenter epidemiological distribution, pathogens, and drug-resistance characteristics of chronic osteomyelitis in
Zemin Liu1,2, Guochao Jin1,2, Le Zhang3,4
1Second Clinical Medical College, Shanxi Medical University, Taiyuan, China.
Introduction:
The incidence of chronic osteomyelitis increases annually. Currently, epidemiological data on chronic osteomyelitis in Central China are scarce. Describing the epidemiological distribution, pathogens, and drug resistance characteristics of patients with chronic osteomyelitis in Central China is critical for its prevention and control. In this study, we aimed to statistically analyze patients with chronic osteomyelitis from four local hospitals to provide a reference for prevention and control in this region.
Methods:
We conducted a retrospective analysis of the clinical data of patients with chronic osteomyelitis admitted to four hospitals in Central China between January 1, 2016, and December 31, 2021, using ICD codes in the electronic medical record system. Data extracted included patients' basic details, hospitalization records, infection status, and bacterial culture results. Statistical descriptions included pathogen detection, distribution, and changes. Furthermore, we analyzed the antibiotic resistance of Gram-positive and -negative bacteria. Patients with positive cultures underwent risk-factor analysis.
Results:
We included 632 patients with chronic osteomyelitis, comprising traumatic osteomyelitis (464 patients), hematogenous osteomyelitis (120 patients), and diabetic foot osteomyelitis (48 patients). The median age was 46 (IQR 30-58) years, and the majority were aged between 41 and 60 years. The male-to-female ratio was 2.49:1. Traffic accidents were identified as the primary etiological factor. The three most commonly affected sites were the tibia, femur, and calcaneus. Among the laboratory indicators, the erythrocyte sedimentation rate had the highest positive rate at 57.71%. Bacterial cultures were performed on the intraoperative specimens of 421 patients and yielded 292 positives (69.36%), of which we identified 386 isolates from 74 pathogens. The most prevalent pathogen were Staphylococcus aureus, Coagulase-negative staphylococci, and Enterobacter spp. (132 [34.20%], 47 [12.18%], and 25 [6.47%] isolates). Gram-positive bacteria were resistant to conventional antibiotics, including penicillin, erythromycin, and clindamycin; however, they were susceptible to peptide antibiotics and oxazolidinones. Gram-negative bacteria were resistant to first- and second-generation cephalosporins; nevertheless, they were sensitive to third- and fourth-generation cephalosporins as well as combinations such as cefoperazone-sulbactam. Multivariate logistic regression analysis identified length of hospital stay (odds ratio [OR] = 1.037, p = 0.001), diabetes (OR = 6.61, p = 0.049), and smoking (OR = 6.873, p = 0.003) as independent risk factors.
Conclusion:
Chronic osteomyelitis predominantly affects middle-aged and older adults, males, and those with tibial injuries from traffic accidents requiring special attention. Staphylococcus aureus was associated with the highest risk of infection. Empirical early-phase medication should be followed by targeted antibiotic therapy based on bacterial sensitivity and resistance. Patients with prolonged hospitalization, diabetes, or a smoking history require special attention. Notably, strengthening health education and postoperative care in these patients can reduce the risk of chronic osteomyelitis.
