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Osteomyelitis associated with pressure sores

R O Darouiche1, G C Landon, M Klima

  • 1Department of Medicine, Baylor College of Medicine, Houston, Tex.

Archives of Internal Medicine
|April 11, 1994
PubMed
Summary
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Accurate diagnosis of osteomyelitis in pressure sores requires bone pathology, as clinical evaluation is unreliable. Quantitative bone cultures do not distinguish osteomyelitis from soft tissue infection, but treating osteomyelitis improves sore healing.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Wound Care

Background:

  • Pressure sores can mask underlying osteomyelitis, complicating diagnosis.
  • Differentiating bone infection from soft tissue infection is clinically challenging.
  • Bone culture contamination is common, hindering accurate diagnosis.

Purpose of the Study:

  • Assess clinical evaluation accuracy for osteomyelitis in pressure sores.
  • Determine if quantitative bone cultures can differentiate osteomyelitis from soft-tissue infection.
  • Evaluate the effect of osteomyelitis treatment on pressure sore outcomes.

Main Methods:

  • 36 patients with pressure sores underwent clinical evaluation and percutaneous bone biopsy.
  • Bone specimens were cultured quantitatively and semiquantitatively for aerobic and anaerobic bacteria.

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  • Pathologic examination of bone tissue served as the gold standard for osteomyelitis diagnosis.

    • Main Results:

    • Osteomyelitis was pathologically confirmed in 6 of 36 patients (17%).
    • Clinical evaluation showed low sensitivity (33%) and specificity (60%) for osteomyelitis.
    • Quantitative bone cultures did not differentiate osteomyelitis from soft-tissue contamination.
    • All patients with confirmed osteomyelitis experienced pressure sore healing after treatment.

    Conclusions:

    • Clinical assessment of osteomyelitis in pressure sores is frequently inaccurate.
    • Pathologic bone examination is essential for definitive osteomyelitis diagnosis.
    • Quantitative bone cultures are not useful for differentiating osteomyelitis from soft-tissue infection.
    • Treating osteomyelitis appears to improve outcomes for associated pressure sores.