Pubic bone osteomyelitis outcomes in patients with malignancies: a case series from an academic cancer center

Introduction: Pubic bone osteomyelitis (PBO) is a rare complication with sometimes delayed development in patients who have received radiotherapy or surgery of the pelvic region for cancer treatment. Treatment options range from antibiotics alone to pubic bone debridement and source control via diversion of gastrointestinal (GI) or genitourinary (GU) tract fistulae. In this single-center case series of patients with cancer, we sought to characterize outcomes of PBO. Methods: We conducted a retrospective analysis of 26 patients, admitted for PBO to Memorial Sloan Kettering Cancer Center between 2017 and 2024. Demographic, clinical presentation, microbiology, treatment, and outcome data were evaluated. Patients were followed until date of death or date of last follow-up. Results: Of the 26 patients, 23 were male (88 %) and 3 were female (12 %), with a median age at diagnosis of 70.5 years. The median follow-up period was 680 d. 18/26 (69 %) had fistulas to the pubic bone. 15 patients (58 %) received antibiotics alone. 11 patients (42 %) underwent pubic bone debridement; 8 underwent additional GI or GU diversion procedures for source control. In the group who received surgery, 9/11 (81 %) were ambulating without assistive devices at end of follow-up. In those receiving antibiotics alone, 9/15 (60 %) died a median of 466 d from diagnosis of PBO. Conclusion: In our case series, a combination of surgical debridement plus targeted antibiotic therapy offered the best outcomes. However, some patients achieved improvement in symptoms with antibiotic management alone when more aggressive surgical interventions were not feasible.