682. The Effect of Antibiotic Treatment Duration on Outcome After Surgical Resection of Pedal Osteomyelitis
Session: Poster Abstract Session: Skin, Soft Tissue and Joint Infections
Friday, October 21, 2011
Room: Poster Hall B1

Background:

Four to six weeks of antibiotics is the commonly accepted minimum duration of therapy for the treatment of osteomyelitis. Infectious Diseases Society of America guidelines suggest that patients without any residual infected bone may be treated for a shorter duration, although there is a paucity of strong evidence to support this. We reviewed the effect of duration of antibiotic therapy in patients who underwent surgical resection for pedal osteomyelitis.  

Methods:

We performed a retrospective review of all patients at our facility who required surgical resection for pedal osteomyelitis (POM). Diagnosis of POM was by radiologic/nuclear studies or by clinical probe-to-bone testing. Decisions regarding length and route of therapy were made by an Infectious Diseases physician. Patients treated with < 21 days of antibiotics (short course) were compared to patients treated with ≥ 21 days (long course).  Relapse was defined as persistent or recurrent infection or progression of bone destruction.

                                

Results:

64 patients underwent surgical resection of infected osteomyelitic bone. 22 patients received short course therapy and 42 received long course, for a mean duration (±SD) of 12 (±4) and 41(±13) days, respectively.  There were no significant differences in the groups with regard to age, gender, ethnicity, diabetes mellitus, tobacco use, atherosclerosis, peripheral vascular disease or comprehensiveness of surgical resection. Of 22 patients who received short course therapy, 18 had negative surgical margins on histopathology or had a surgical notation of complete resection of all infected bone. At 3 months following surgery, patients who received a short course of therapy had a relapse rate of 50%, as compared to a relapse rate of 18% among those who received a longer course of therapy (p=0.01).

Conclusion:

Patients who were treated with antibiotics for a mean of 41 days had a significantly higher cure rate than those treated for a mean of 12 days.  Factors other than the adequacy of surgical resection need to be considered in determining the suitability of short course therapy. Further research is required to better characterize patients that are appropriate candidates for short course therapy.

 


Subject Category: J. Clinical practice issues

Abdur Khan, MD1,2, Laila Fernandes, MD1,2, Ronald Markert, PhD2 and Jack Bernstein, MD1,2, (1)Veterans Affairs Medical Center, Dayton, OH, (2)Wright State University, Dayton, OH

Disclosures:

A. Khan, None

L. Fernandes, None

R. Markert, None

J. Bernstein, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.