Bone Joint Infections Research Articles

Experimental Models of Bone and Prosthetic Joint Infections

Bone and joint infections are difficult to cure. The difficulty is related to the presence of bacteria adherent to foreign material in many cases and also to the limited activity of antibiotics in infected bones. Clinical trials are difficult to design because of the heterogeneity of the disease and the number of factors that could influence the therapeutic response. To control for these multiple variables, attempts have been made to develop reliable animal models of osteomyelitis and prosthetic joint infections that closely mimic the different infections seen in orthopedic surgery and that allow evaluation of the efficacy of surgical procedures as well as local or systemic antibiotic therapy. These models will continue to provide us information on the pathogenesis and management of such infections.

Acute osteoarticular infection in childhood

Bone infection (osteomyelitis, osteitis) and joint infection (septic arthritis, suppurative arthritis, infective arthritis) appear to carry a bad reputation. However, in childhood, when, the way in which the causative organisms enter and infect bone or joint is usually by the arterial blood supply, these is a good potential for cure. In developed countries the sight of a cripple with a limp, a short leg, a stiff joint and a smelly discharging sinus is rare-despite pictures in textbooks which colour the appreciation of the diseases. Bone and joint infections in children are uncommon; therefore the satisfactory experiences of those who treat a significant number of such children is not well conveyed to the medical population in general, as well as to orthopaedic surgeons, thereby leading to controversy about diagnosis and treatment. Such controversies are largely based on ignorance, emotion, uncertainty and inadequate audit of outcome. Among those who have more experience, there is little disagreement about management of bone and joint infection in childhood. This article should convince the reader that there is a rational plan for management of osteoarticular infection in childhood based upon an understanding of the pathogenesis of the diseases and clear clinical indicators on which to base decisions.

Cefonicid in a once-daily regimen for treatment of osteomyelitis in an ambulatory setting.

Fifteen patients with bone joint infections were treated with 1.0 g of cefonicid administered intravenously or intramuscularly once daily. Single organisms isolated included Staphylococcus aureus (from six patients), Staphylococcus epidermidis (three), and Peptococcus species (one). For four patients infection was polymicrobial, and for one patient no organism was isolated. The mean duration of therapy was 40.4 days, only 10.9 days of which were spent in the hospital. The remainder of therapy was administered intramuscularly in an ambulatory setting. Therapy was successful in all 12 assessable patients. No clinical or bacteriologic relapse occurred in the follow-up period of three to 13 months. The occurrence of adverse effects prompted discontinuation of cefonicid therapy in three patients. Minimum savings in hospital-bed costs alone were $64,350, with 390 hospital days avoided. The minimum savings in work income were $10,010, with 182 days of absenteeism avoided. These data are preliminary but suggest efficacy of cefonicid in a mode of therapy that could have profound cost benefits.