| OBJECTIVE To investigate the epidemiological,clinical and microbiological characteristics of patients with traumatic osteomyelitis in the limbs,and provide evidence-based guidance for early diagnosis and treatment,including empirical antibiotic therapy.Method This study was a retrospective study approved by the Institutional Review Board of Zunyi Medical University.A total of 5,368 patients who had been confirm with limb traumatic fracture were enrolled in this study.The history of microbiology laboratory was reviewed.The wound positive or biopsy positive was regarded as the final inclusion criteria.Patients who met the above two diagnostic criteria were selected as the final cases,and their outpatient and inpatient records was collected,including epidemiological,clinical manifestations,bacterial culture results and drug resistance.Microbial resistance was determined by the M-100-S22 protocol(Clinical & Laboratory Standards Institute?(CLSI)2012 USA).Results According to the clinical symptoms of patients' symptoms,signs and imaging as well as the results of positive bacterial culture,84 patients(1.56%)were diagnosed with osteomyelitis.Tibia and fibula were the most common infection sites(47.62%).Of these,66(78.57%)were single bacterial infections and 18(21.43%)were multiple bacterial infections.The infection was mainly caused by Gram-positive bacteria.The most common Gram-positive bacteria were Staphylococcus aureus(S.aureus)(39 patients,37.50%)and Staphylococcus epidermidis(6 cases,5.77%),both of which were sensitive to ampicillin,quinuprine / dalfopristin,linezolid,tigecycline,nitrofurantoin and vancomycin.Staphylococcus aureus is the most common pathogen in single and multiple bacterial infections.All 17 cases of methicillin-resistant Staphylococcus aureus(MRSA)infection were sensitive to morpholinonone,ampicillin,quinupristin / dalfopristin,linezolid,tigecycline,nitrofurantoin,piperacillin / Tazobactam,rifampicin and vancomycin.The most common Gram-negative bacteria were Escherichia coli(16 cases,15.38%)and Enterobacter cloacae(11 cases,10.58%),both of which were sensitive to thiamycin.Conclusions The average incidence rate of patients who were treated in Affiliated hospital of Zunyi Medical College for limb traumatic osteomyelitis(1.56%)from the neighboring southwest provinces was 2.6-7.8%.The main complications were osteofascial compartment syndrome,diabetes and hypertension.The most common lower limb infection was single bacterial infection.Staphylococcus aureus was the most common pathogen.There were a total of 39 staphylococcus aureus infection cases(37.50%),of which 17 cases(43.59%)was caused by MRSA.These findings provide reference for the treatment of patients with traumatic osteomyelitis in southwest areas with empirical usage of antibioticsOBJECTIVE To explore the sensitivity in multivariate diagnosis of traumatic osteomyelitis and to analyze the diagnosis status of traumatic bone infection based on regional diagnosis characteristics.The present study is aimed to provide evidence-based medical basis for the early diagnosis and treatment of traumatic osteomyelitis and the empirical use of antibiotics.Method The clinical study was approved by the Ethics Committee.5,368 patients who had been diagnosed with limb traumatic osteomyelitis from January 1st,2012 to December 31 th,2015 were enrolled in this study.The history of microbial chamber records and hospital medical records were reviewed.The “wound secretion positive or biopsy positive” was regarded as inclusion criteria.Microbial resistance followed the M-100-S22 protocol(Clinical & Laboratory Standards Institute?(CLSI)2012 USA).The information collected included age,sex,history,infection site,clinical symptoms,white blood cell count(WBC),neutrophil ratio(NEUT%.),neutrophil absolute value(NEUT #),erythrocyte sedimentation rate.C-reactive protein test,reactive protein detection,X-ray,computed tomography(CT),and magnetic resonance imaging(MRI)were performed to explore how to improve the diagnostic level of traumatic osteomyelitis under existing conditions.Result 84 patients(1.56%)were diagnosed with osteomyelitis based on positive symptoms,signs and imaging.The most common clinical symptoms and signs included local infiltration(68 cases,81%),limited activity(63 cases,75%),local abscess(52 cases,62%).Laboratory examination showed that the sensitivity of the C-reactive protein was 78.57%(66 positive cases),the sensitivity of white blood cell count was 76.19%(64 positive cases),the sensitivity of neutrophils was 73.81%(62 positive cases),ESR sensitivity was 67.86%(57 positive cases),neutrophil absolute sensitivity was 64.29(54 positive cases positive).Imaging examination showed that the most common manifestations of X-ray included tissue swelling(47 cases 74.60%),bone defect(20 cases,31.75%).The most common manifestations of CT were Bone destruction or hyperplasia(20 cases,80.00%),bone defect(11 cases,44.00%).The most common manifestations of nuclear magnetic resonance(MRI)included bone marrow edema(4 cases,57.14%),bone defect(3 cases,42.86%).84 patients with traumatic osteomyelitis who were diagnosed by positive wound or bone biopsy were retrospectively analyzed in terms of clinical manifestations,Gustilo typing,internal medicine complications,laboratory tests,imaging studies according to "osteomyelitis diagnostic score(ODS)" proposed by German physician Sehmidt et al in 2011.The diagnosis score totally included 65 points.Scoring 0 to 15 points refers to no traumatic osteomyelitis is considered,scoring 16 to 30 points refers to initial suspicion of traumatic osteomyelitis,scoring 31 to 45 points refers to highly suspected traumatic osteomyelitis,scoring 46 to 65 points refers to basically confirmed traumatic osteomyelitis.Of all 84 patients confirmed with traumatic osteomyelitis,67(79.76%)patients had a score of 46 or more and 12(14.29%)had a score of 31 to 45,with a total sensitivity of 94.05%.Conclusion The diagnosis of traumatic osteomyelitis is very difficult,especially early and rapid diagnosis.As of now,there is still a lack of a single indicator as a diagnostic criteria,and multi-factor comprehensive consideration is still needed.Through retrospective analysis of 84 patients comfired with traumatic osteomyelitis,the "Bone Infection Diagnostic Score" was preliminarily developed,which has a certain clinical value and deserves further promotion and improvement.By sticking to the patient-centered treatment concept,and actively using new technologies and new methods,the diagnosis and treatment of traumatic osteomyelitis is expected to improved continuously. |
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