Successful treatment of Pseudomonas aeruginosa osteomyelitis with antibiotic monotherapy of limited duration

J Infect. 2017 Sep;75(3):198-206. doi: 10.1016/j.jinf.2017.06.006. Epub 2017 Jun 28.

Abstract

Objectives: The aim of this study was to present a 15-year experience and provide a comprehensive analysis of a large cohort of patients with Pseudomonas aeruginosa osteomyelitis.

Methods: We reviewed the medical records of patients admitted to a large French university hospital for P. aeruginosa osteomyelitis over a 15-year period. Patient outcome was assessed at follow-up after at least six months.

Results: Sixty-seven patients were included, comprising 57% with chronic osteomyelitis. Polymicrobial infection was predominant (63%), and an infected device was involved in 39% patients. The overall treatment success rate was 79.1%. All but one patient were treated with a combination of surgery and antibiotic therapy. The antibiotic treatment had a mean duration of 45 days (range, 21-90 days). Single-antibiotic therapy was preferred in nearly all cases. Treatment failure was reported for 14 (21%) patients and was due to the persistence of P. aeruginosa in four cases. No significant risk factor for treatment failure was identified, especially when treatment strategies were compared.

Conclusions: We advocate optimal surgical debridement combined with initial parenteral antibiotics for a maximum of 15 days, followed by an oral fluoroquinolone. Total treatment duration should not exceed six weeks, and antibiotic treatment with two-drug combinations does not seem necessary.

Keywords: Antibiotics; Osteitis; Osteomyelitis; Pseudomonas aeruginosa; Treatment.

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Debridement
  • Female
  • Follow-Up Studies
  • Hospitals, University
  • Humans
  • Male
  • Medical Records
  • Middle Aged
  • Osteomyelitis / drug therapy*
  • Osteomyelitis / etiology
  • Osteomyelitis / microbiology*
  • Pseudomonas Infections / complications
  • Pseudomonas Infections / drug therapy*
  • Pseudomonas Infections / microbiology
  • Pseudomonas aeruginosa / drug effects*
  • Pseudomonas aeruginosa / isolation & purification
  • Time Factors
  • Treatment Outcome
  • Young Adult

Substances

  • Anti-Bacterial Agents