224. Pressure Ulcer-Related Pelvic Osteomyelitis: Evaluation of a Two-Stage Surgical Strategy (Debridement, Negative Pressure Therapy and Flap Coverage) with Prolonged Antimicrobial Therapy
Session: Poster Abstract Session: Clinical: Bone and Joint Infection
Thursday, October 5, 2017
Room: Poster Hall CD
Background: A two-stage surgical strategy (debridement-negative pressure therapy (NPT) and flap coverage) with prolonged antimicrobial therapy is usually proposed in pressure ulcer-related pelvic osteomyelitis but has not been widely evaluated.

Methods: Adult patients with pressure ulcer-related pelvic osteomyelitis treated by a two-stage surgical strategy were included in a retrospective cohort study. Determinants of superinfection (i.e., additional microbiological findings at reconstruction) and treatment failure were assessed using binary logistic regression and Kaplan-Meier curve analysis.

Results: Sixty-four pressure ulcer-related pelvic osteomyelitis in 61 patients (age, 47 (IQR, 36-63)) were included. Osteomyelitis was mostly plurimicrobial (73%), with a predominance of S. aureus (47%), Enterobacteriaceae (44%) and anaerobes (44%). Flap coverage was performed after 7 (IQR, 5-10) weeks of NPT, with 43 (68%) positive bone samples among which 39 (91%) were superinfections, associated with a high ASA score (OR, 5.8; p=0.022). An increased prevalence of coagulase negative Staphylococci (p=0.017) and Candida (p=0.003) was observed at time of flap coverage. An ESBL Enterobacteriaceae was found in 5 (12%) patients, associated with fluoroquinolone consumption (OR, 32.4; p=0.005). Treatment duration was as 20 (IQR, 14-27) weeks, including 11 (IQR, 8-15) after reconstruction. After a follow-up of 54 (IQR, 27-102) weeks, 15 (23%) failures were observed, associated with previous pressure ulcer (OR, 5.7; p=0.025) and Actinomyces infection (OR, 9.5; p=0.027).

Conclusion: Pressure ulcer-related pelvic osteomyelitis is a difficult-to-treat clinical condition, generating an important consumption of broad-spectrum antibiotics. Carbapenem should be reserved for ESBL at-risk patients only, including those with previous fluoroquinolone use. The uncorrelation between outcome and the debridement-to-reconstruction interval argue for a short sequence to limit the total duration of treatment.

Tristan Ferry, MD, PhD1, Fabien Boucher, MD2, Joseph Chateau, MD2, Hristo Shipkov, MD2, Fatiha Daoud, MD2, Evelyne Braun, MD2, Claire Triffault-Fillit, MD2, Thomas Perpoint, MD3, Frederic Laurent, DPharm, PhD4, Alain-Ali Mojallal, MD, PhD5, Christian Chidiac, MD, PhD2, Florent Valour, MD, PhD2, Johan Andrianasolo, MD5 and Lyon BJI Study group, (1)Inserm 1111, UCBL1, Hospices Civils de Lyon, Lyon, France, (2)ID Department, Regional Reference Center for Bji, Hospices Civils de Lyon, Lyon, France, (3)Hospices Civils de Lyon, Lyon, France, (4)Laboratory of Bacteriology, Regional Reference Center for Bji, Hospices Civils de Lyon, Lyon, France, (5)Hospices Civils de Lyon - Hôpital de la Croix-Rousse, Lyon, France

Disclosures:

T. Ferry, HERAEUS: Consultant , Speaker honorarium

F. Boucher, None

J. Chateau, None

H. Shipkov, None

F. Daoud, None

E. Braun, None

C. Triffault-Fillit, None

T. Perpoint, None

F. Laurent, None

A. A. Mojallal, None

C. Chidiac, None

F. Valour, None

J. Andrianasolo, None

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