Abstract
Aim: Chronic osteomyelitis is still a difficult problem to treat in the developed world, but even more so in low- and middle-income countries. Contemporary treatment options result in satisfying outcomes in a setting with abundant resources, but the question is whether these treatment options can be translated to other, less supported health care systems and if they obtain the same results. Methods: Eighteen patients with established chronic osteomyelitis (eight type III, ten type IV) were prospectively enrolled and treated in a one-stage procedure with radical debridement and dead space management using bioactive glass S53P4 granules, together with adjuvant antibiotic therapy. Results: Thirteen patients were assessed at 24 months. Infection control was achieved in five patients (38%). Eight patients (61.5%) had persistence or recurrence of infection. Loss to follow-up was substantial (five patients, 28%). Conclusion: Due to specific challenges treating chronic osteomyelitis in low- and middle-income countries, contemporary treatment options cannot be ‘copy-pasted’ with the same results in these settings. Level of evidence: Level 4
Highlights
Chronic osteomyelitis is still a difficult problem to treat in the developed world, but even more so in developing, low- and middleincome countries (LMICs)
Musculoskeletal infections in general can be the reason for hospital admission in as much as 14.5% of cases in these countries.[1]. Contemporary treatment options, such as the use of bioactive glass in a one-stage setting, result in satisfying outcomes in a setting with abundant resources, but the question is whether these treatment options can be translated to other, less supported health care systems and if they obtain the same results
The duration of the course of antibiotics is generally recommended to be six weeks 26,27 which is often impossible in LMICs due to financial restraints, thereby compromising a favourable outcome.[27]
Summary
Chronic osteomyelitis is still a difficult problem to treat in the developed world, but even more so in developing, low- and middleincome countries (LMICs). Musculoskeletal infections in general can be the reason for hospital admission in as much as 14.5% of cases in these countries.[1] Contemporary treatment options, such as the use of bioactive glass in a one-stage setting, result in satisfying outcomes in a setting with abundant resources, but the question is whether these treatment options can be translated to other, less supported health care systems and if they obtain the same results. Specific challenges come with the treatment of chronic osteomyelitis in the setting of low- and middle-income countries: lack of good diagnostic tools (imaging as well as microbiology), availability of proper antibiotics and the possibility of administering these intravenously and for the proper length of time, conditions of surgery and adequate follow-up possibilities.[2] This often results in misdiagnosis and/or under-treatment.[3] Treatment often requires long hospitalisation which can lead to financial problems for the affected patients and their families as well as the health care system of the country concerned. The aim of this study was to evaluate if a favourable outcome could be obtained using a treatment protocol from a European dedicated infection unit (Maastricht University Medical Centre, the Netherlands) in a setting with much fewer resources
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