Ostéite chronique de l’adulte. Diagnostic et prise en charge

Abstract

Objective Update on the diagnostic procedures and management of chronic osteomyelitis in adults. Methods This update was produced from articles and reviews of the literature and our experience in this field. Pathogenesis Osteomyelitis in adults is mostly observed after trauma or bone surgery and can be associated with foreign-body implants. Chronic evolution and relapses are due to local factors (vascular insufficiency, presence of a foreign-body, persistence of bone sequestra…), host factors (diabetes, drepanocytosis…) and microbial factors (adhesion, synthesis of biofilm, development od small colony variants, resistance to antibiotics…). Diagnosis Clinical manifestations include bone pain and/or local swelling, a fistula; fever is rarely observed in chronic osteomyelitis. Computer tomography and magnetic resonance imaging are needed to evaluate the extension of the lesions and guide the surgical treatment. The most important part of the diagnosis is to isolate the offending organism(s). Multiple intraoperative tissue specimens must be taken and cultured for prolonged times in enriched media. Treatment A multidisciplinary approach is needed for the management of these infections. Surgical treatment consists of extensive debridment, removal of foreign material, dead bone and infected tissues. Antimicrobial therapy should associate antibiotics with good bone penetration that are active against the isolated microorganism(s), and well tolerated by the patient. High dose combination intravenous therapy is often needed during the first weeks of treatment.