The Experts below are selected from a list of 285 Experts worldwide ranked by ideXlab platform
Brad Spellberg - One of the best experts on this subject based on the ideXlab platform.
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systemic antibiotic therapy for Chronic Osteomyelitis in adults
Clinical Infectious Diseases, 2012Co-Authors: Brad Spellberg, Benjamin A LipskyAbstract:The standard recommendation for treating Chronic Osteomyelitis is 6 weeks of parenteral antibiotic therapy. However, oral antibiotics are available that achieve adequate levels in bone, and there are now more published studies of oral than parenteral antibiotic therapy for patients with Chronic Osteomyelitis. Oral and parenteral therapies achieve similar cure rates; however, oral therapy avoids risks associated with intravenous catheters and is generally less expensive, making it a reasonable choice for Osteomyelitis caused by susceptible organisms. Addition of adjunctive rifampin to other antibiotics may improve cure rates. The optimal duration of therapy for Chronic Osteomyelitis remains uncertain. There is no evidence that antibiotic therapy for >4–6 weeks improves outcomes compared with shorter regimens. In view of concerns about encouraging antibiotic resistance to unnecessarily prolonged treatment, defining the optimal route and duration of antibiotic therapy and the role of surgical debridement in treating Chronic Osteomyelitis are important, unmet needs.
Benjamin A Lipsky - One of the best experts on this subject based on the ideXlab platform.
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systemic antibiotic therapy for Chronic Osteomyelitis in adults
Clinical Infectious Diseases, 2012Co-Authors: Brad Spellberg, Benjamin A LipskyAbstract:The standard recommendation for treating Chronic Osteomyelitis is 6 weeks of parenteral antibiotic therapy. However, oral antibiotics are available that achieve adequate levels in bone, and there are now more published studies of oral than parenteral antibiotic therapy for patients with Chronic Osteomyelitis. Oral and parenteral therapies achieve similar cure rates; however, oral therapy avoids risks associated with intravenous catheters and is generally less expensive, making it a reasonable choice for Osteomyelitis caused by susceptible organisms. Addition of adjunctive rifampin to other antibiotics may improve cure rates. The optimal duration of therapy for Chronic Osteomyelitis remains uncertain. There is no evidence that antibiotic therapy for >4–6 weeks improves outcomes compared with shorter regimens. In view of concerns about encouraging antibiotic resistance to unnecessarily prolonged treatment, defining the optimal route and duration of antibiotic therapy and the role of surgical debridement in treating Chronic Osteomyelitis are important, unmet needs.
Elton Strauss - One of the best experts on this subject based on the ideXlab platform.
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surgical management of Chronic Osteomyelitis
American Journal of Surgery, 2004Co-Authors: Brad Parsons, Elton StraussAbstract:Chronic Osteomyelitis is a surgical disease that can require significant dedication from both patients and surgeons to eradicate. Osteomyelitis can result from a variety of etiologies but most often is a consequence of trauma to a long bone, frequently the tibia. It is important to understand the etiology of the infection, as well as the pathophysiology of its Chronicity. Additionally, the surgeon must individualize treatment for each patient, because host morbidities often play an important role in propagation of infection. Treatment requires isolation of the pathogens, significant debridement for removal of all infective and necrotic material, and then bony and soft tissue reconstruction. We review the literature of surgical treatment of Chronic Osteomyelitis and discuss the numerous techniques available to the treatment team, including debridement, dead space management, Ilizarov techniques, and vascularized reconstruction. These patients often require a multimodality approach that incorporates a team approach involving orthopedic and plastic surgery, as well as infectious disease and general medicine.
Marilia D Turchi - One of the best experts on this subject based on the ideXlab platform.
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antibiotics for treating Chronic Osteomyelitis in adults
Cochrane Database of Systematic Reviews, 2013Co-Authors: Lucieni De Oliveira Conterno, Marilia D TurchiAbstract:Background Chronic Osteomyelitis is generally treated with antibiotics and surgical debridement but can persist intermittently for years with frequent therapeutic failure or relapse. Despite advances in both antibiotic and surgical treatment, the long-term recurrence rate remains around 20%. This is an update of a Cochrane review first published in 2009. Objectives To determine the effects of different systemic antibiotic treatment regimens for treating Chronic Osteomyelitis in adults. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (October 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 9), MEDLINE (January 1948 to September Week 4 2012), EMBASE (January 1980 to 2012 Week 40), LILACS (October 2012), the WHO International Clinical Trials Registry Platform (June 2012) and reference lists of relevant articles. Selection criteria Randomised controlled trials (RCTs) or quasi-RCTs addressing the effects of different antibiotic treatments given after surgical debridement for Chronic Osteomyelitis in adults. Data collection and analysis Two review authors independently screened papers for inclusion, extracted data and appraised risk of bias in the included trials. Where appropriate, we pooled data using the fixed-effect model. Main results We included eight small trials involving a total of 282 participants with Chronic Osteomyelitis. Data were available from 248 participants. Most participants were male with post-traumatic Osteomyelitis, usually affecting the tibia and femur, where recorded. The antibiotic regimens, duration of treatment and follow-up varied between trials. All trials mentioned surgical debridement before starting on antibiotic therapy as part of treatment, but it was unclear in four trials whether all participants underwent surgical debridement. We found that study quality and reporting were often inadequate. In particular, we judged almost all trials to be at moderate to high risk of bias due to failure to conceal allocation and inadequate follow-up. Four trials compared oral versus parenteral route for administration of antibiotics. There was no statistically significant difference between the two groups in the remission at the end of treatment (70/80 versus 58/70; risk ratio (RR) 1.04, 95% confidence interval (CI) 0.92 to 1.18; four trials, 150 participants). There was no statistically significant difference between the two groups in the remission rate 12 or more months after treatment (49/64 versus 44/54; RR 0.94, 95% CI 0.78 to 1.13; three trials, 118 participants). There was also no significant difference between the two groups in the occurrence of mild adverse events (11/64 versus 8/54; RR 1.08, 95% CI 0.49 to 2.42; three trials, 118 participants) or moderate and severe adverse events (3/49 versus 4/42; RR 0.69, 95% CI 0.19 to 2.57; three trials, 91 participants). Superinfection occurred in participants of both groups (5/66 in the oral group versus 4/58 in the parenteral group; RR 1.08, 95% CI 0.33 to 3.60; three trials, 124 participants). Single trials with few participants found no statistical significant differences for remission or adverse events for the following four comparisons: oral only versus parenteral plus oral administration; parenteral plus oral versus parenteral only administration; two different parenteral antibiotic regimens; and two different oral antibiotic regimens. No trials compared different durations of antibiotic treatment for Chronic Osteomyelitis, or adjusted the remission rate for bacteria species or severity of disease. Authors' conclusions Limited and low quality evidence suggests that the route of antibiotic administration (oral versus parenteral) does not affect the rate of disease remission if the bacteria are susceptible to the antibiotic used. However, this and the lack of statistically significant differences in adverse effects need confirmation. No or insufficient evidence exists for other aspects of antibiotic therapy for Chronic Osteomyelitis. The majority of the included trials were conducted over 20 years ago and currently we are faced with a far higher prevalence of bacteria that are resistant to many of the available antibiotics used for healthcare. This continuously evolving bacterial resistance represents another challenge in the choice of antibiotics for treating Chronic Osteomyelitis.
Leonard Charles Marais - One of the best experts on this subject based on the ideXlab platform.
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REFINING HOST STRATIFICATION IN Chronic Osteomyelitis
2018Co-Authors: Leonard Charles Marais, Nando Ferreira, Colleen Aldous, Benn Sartorius, Le Roux TlbAbstract:Despite numerous advances in the management of Chronic Osteomyelitis, many questions remain. To date, no evidence-based guidelines exist in the treatment of Chronic Osteomyelitis. In essence the aim is to improve quality of life through either a curative or a palliative treatment strategy. The choice of treatment strategy is based on the physiological status of the host. This process of host stratification is, however, complicated by the fact that the definition of a C-host has never been standardized.Purpose;The aim of the study was to investigate the short term outcome of the treatment of Chronic Osteomyelitis in adult patients where selection of a management strategy was based on a refined host stratification system.Methods;A retrospective review was performed of adult patients with Chronic Osteomyelitis seen over a one year period. In total 116 patients were included in the study. A modified host stratification system was applied, incorporating predefined major and minor criteria, to determine each pa...
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REFINING HOST STRATIFICATION IN Chronic Osteomyelitis
Journal of Bone and Joint Surgery-british Volume, 2014Co-Authors: Leonard Charles Marais, Nando Ferreira, Colleen Aldous, Benn Sartorius, Tlb Le RouxAbstract:Despite numerous advances in the management of Chronic Osteomyelitis, many questions remain. To date, no evidence-based guidelines exist in the treatment of Chronic Osteomyelitis. In essence the aim is to improve quality of life through either a curative or a palliative treatment strategy. The choice of treatment strategy is based on the physiological status of the host. This process of host stratification is, however, complicated by the fact that the definition of a C-host has never been standardized. Purpose; The aim of the study was to investigate the short term outcome of the treatment of Chronic Osteomyelitis in adult patients where selection of a management strategy was based on a refined host stratification system. Methods; A retrospective review was performed of adult patients with Chronic Osteomyelitis seen over a one year period. In total 116 patients were included in the study. A modified host stratification system was applied, incorporating predefined major and minor criteria, to determine each patient9s host status. Results; A high prevalence of HIV infection (28.6%) and malnutrition (15%) was present in the study population. Almost half the patients were classified as C-hosts (44.8% or n=52), followed by B-host classification in 39.7% of cases (n=46). At a mean follow-up of one year an overall success rate of 91.4% (95% CI: 84.7–95.8%) was achieved. Host status and outcome (remission, suppression or failure) was significantly dependent (p-value Conclusion; By integrating the physiological status of the host (based on objective predefined criteria) with the appropriate curative, palliative or alternative treatment strategy we were able to achieve acceptable outcomes in both low and high risk cases and, in addition, avoid unnecessary amputation.
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The classification of Chronic Osteomyelitis
SA Orthopaedic Journal, 2014Co-Authors: Leonard Charles Marais, Nando Ferreira, Colleen Aldous, Theo L.b. Le RouxAbstract:As a result of the heterogeneous nature of Chronic Osteomyelitis and the complexity of management strategy formulation, more than ten classification systems have been published over the past 40 years. Historical systems, used in the classification of Chronic Osteomyelitis, remain useful in terms of the description of the nature and origin of the disease. They fail, however, to provide the user with sufficient information in order to select the appropriate treatment strategy. As a result, more comprehensive classifications have subsequently been proposed. Accurate host stratification, in particular, is considered to be essential. The physiological status of the host serves as the primary indicator of the patient’s ability to effect healing of bone and soft tissues, as well as their ability to launch an effective immune response in conjunction with antibiotic therapy. Despite the development of more comprehensive classification systems, many shortcomings remain within the domain of disease classification and host stratification.
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The management of Chronic Osteomyelitis
SA Orthopaedic Journal, 2014Co-Authors: Leonard Charles Marais, Nando Ferreira, Colleen Aldous, Tlb Le RouxAbstract:To date, no evidence-based guidelines for the treatment of Chronic Osteomyelitis exist. Owing to certain similarities, treatment philosophies applicable to musculoskeletal tumour surgery may be applied in the management of Chronic Osteomyelitis. This novel approach not only reinforces certain important treatment principles, but may also allow for improved patient selection as surgical margins may be customised according to relevant host factors. When distilled to its most elementary level, management is based on a choice between either a palliative or curative approach. Unfortunately there are currently no objective criteria to guide selection of the most appropriate treatment pathway. The pre-operative diagnostic work-up should be tailored according to the relevant objective, albeit confirming the clinical suspicion of the presence of infection, host stratification, anatomical disease classification, pre-operative planning or post-operative follow-up. MRI and PET-CT are emerging as the imaging modalities of choice. Interleukin-6, in combination with CRP, has been shown to have excellent sensitivity in the diagnosis of implant-associated infection. Molecular methods are growing rapidly as the method of choice in pathogen detection. Chronic Osteomyelitis, as is the case with musculoskeletal tumours, can only be eradicated through complete resection of all infected bone. Chemotherapy, in the form of antibiotics, only plays an adjuvant role. Dead space management is essential following debridement, and the appropriate strategy should be selected according to the anatomical nature of the disease. Provision of adequate bony stability is crucial as it promotes revascularisation and maximisation of the host’s immune response. Although there is currently a variety of fixation options available, external fixation is generally preferred.
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The pathophysiology of Chronic Osteomyelitis
SA Orthopaedic Journal, 2013Co-Authors: Nando Ferreira, Colleen Aldous, Leonard Charles MaraisAbstract:Chronic Osteomyelitis is a biofilm-based infection of bone where the majority of causative microorganisms are sessile in nature, rendering them less sensitive to systemic antibiotic agents and making routine culture techniques unreliable. Biofilms are the characteristic growth pattern for most bacteria and are now understood to consist of interactive communities with the ability to alter their gene expression in order to ensure survival. Our knowledge of the host’s response to infection is also rapidly expanding. The discovery that osteoclastic and osteoblastic cells play a central role in the immune response of bone has resulted in a better understanding of osteo-immunology. This expansion of knowledge has created new opportunities in terms of the development of novel treatment strategies in the management of Chronic Osteomyelitis and periprosthetic infections.