Osteomyelitis In Adults Research Articles

Hand Osteomyelitis: A Systematic Review of the Literature and Recommendations for Diagnosis and Management.

Hand osteomyelitis is a complex condition to diagnose and treat, with an opportunity to improve care through organization of existing evidence. The literature was systematically searched for series of hand osteomyelitis between 1990 and 2022 for evidence regarding diagnosis and treatment, to formulate recommendations. Twenty-one series reported at least 5 cases of hand osteomyelitis in adults, with a total of 666 cases. Surgical debridement is central to treatment and oral antibiotics are sufficient for individuals without diabetes, renal or vascular disease, after debridement and resolution of associated sepsis. A 4- to 6-week duration of antibiotic therapy according to organism sensitivities is recommended, or a 2-week course after amputation. Delayed presentation is common and if over 6 months is associated with high amputation rates. Hand osteomyelitis with renal failure is associated with systemic complications. Reconstruction options include antibiotic-eluting spacers, osteosynthesis or arthrodesis, vascularized bone or adipose, regional soft tissue coverage and silicone implant arthroplasty.Level of Evidence: IV.

Diagnostic efficacy and clinical impact of image-guided core needle biopsy of suspected vertebral osteomyelitis

ObjectivesThe diagnostic yield and clinical impact of image-guided core needle biopsy (ICNB) of suspected vertebral osteomyelitis in adults is heterogenous in published studies owing to small sample sizes, indicating the need for large cohort studies. MethodsA retrospective analysis of ICNBs was performed from 2010 to 2021 for patients with imaging findings consistent with vertebral osteomyelitis. For each biopsy, a series of factors were analyzed, as well as if histopathology was diagnostic of osteomyelitis and if microbiological cultures were positive. In addition, it was recorded in what way biopsy influenced clinical management regarding antimicrobial treatment. A multivariate statistical analysis was performed to evaluate the factors associated with yield. ResultsA total of 570 biopsies performed on 527 patients were included. A histopathologic diagnosis of osteomyelitis was made in 68.4% (359 of 525) of biopsies, and microbiological cultures were positive in 29.6% (169 of 570). Elevated erythrocyte sedimentation rate was positively associated with a histopathologic diagnosis of osteomyelitis (odds ratio [OR] =1.96, P = 0.007) and positive cultures from bone cores (OR = 1.02, P ≤0.001) and aspirate (OR = 1.02, P ≤0.001). Increased total core length was positively associated with a histopathologic diagnosis of osteomyelitis (OR = 1.81, P = 0.013) and positive cultures from bone cores (OR = 1.65, P = 0.049). Clinical management was affected by ICNB in 37.5% (214 of 570) of cases. ConclusionsIn this large cohort, ICNB yielded approximately 30% positive cultures and changed clinical management in over one-third of the patients.

Chronic Nonspinal Osteomyelitis in Adults: Consensus Recommendations on Percutaneous Bone Biopsies from the Society of Academic Bone Radiologists.

The diagnosis and management of chronic nonspinal osteomyelitis can be challenging, and guidelines regarding the appropriateness of performing percutaneous image-guided biopsies to acquire bone samples for microbiological analysis remain limited. An expert panel convened by the Society of Academic Bone Radiologists developed and endorsed consensus statements on the various indications for percutaneous image-guided biopsies to standardize care and eliminate inconsistencies across institutions. The issued statements pertain to several commonly encountered clinical presentations of chronic osteomyelitis and were supported by a literature review. For most patients, MRI can help guide management and effectively rule out osteomyelitis when performed soon after presentation. Additionally, in the appropriate clinical setting, open wounds such as sinus tracts and ulcers, as well as joint fluid aspirates, can be used for microbiological culture to determine the causative microorganism. If MRI findings are positive, surgery is not needed, and alternative sites for microbiological culture are not available, then percutaneous image-guided biopsies can be performed. The expert panel recommends that antibiotics be avoided or discontinued for an optimal period of 2 weeks prior to a biopsy whenever possible. Patients with extensive necrotic decubitus ulcers or other surgical emergencies should not undergo percutaneous image-guided biopsies but rather should be admitted for surgical debridement and intraoperative cultures. Multidisciplinary discussion and approach are crucial to ensure optimal diagnosis and care of patients diagnosed with chronic osteomyelitis.

A Review of the Clinical Utilization of Oral Antibacterial Therapy in the Treatment of Bone Infections in Adults.

Chronic osteomyelitis in adults is managed with prolonged courses of intravenous antibiotics in conjunction with surgical debridement of necrotic bone. Over the past 40 years, there has been no paradigm shift in this approach, as randomized controlled trials of this standard of care compared to alternatives such as prolonged oral antibiotics are scarce. However, there have been many small trials, case reports, and review papers evaluating the effectiveness of oral treatment for chronic osteomyelitis. The oral route for infections requiring prolonged treatment is intuitively and practically more favorable due to several advantages, the most important of which is the avoidance of long-term IV antimicrobial therapy with its complications, inconvenience, and cost. In this paper, we review the literature evaluating oral antibiotic therapy in the management of chronic bone infections since 1975. The majority of osteomyelitis infections are caused by Staphylococcus aureus, hence we focus on its treatment using oral antibiotics; however, we also emphasize subpopulations of patients with diabetes, implanted hardware, and with less common bacterial organisms. The primary objective of this review is to promulgate clinical recommendations on the use of oral antibiotics in bone infections in the context of initial therapy, transition from intravenous therapy, and the role of chronic suppression. The secondary objective is to summarize current knowledge of the specific oral antimicrobial agents that are commonly utilized, together with a synopsis of the available literature pertaining to their pharmacokinetic/pharmacodynamic properties and duration of therapy in bone infection.

Neonatal osteomyelitis: A case series

Background: Osteomyelitis in the neonatal age group is a rare entity. Its presentation and progression are quite different from osteomyelitis in adults, adolescents, and even children. Due to vague clinical features and the late appearance of changes on X-rays, the diagnosis often gets missed. Additionally, there is a risk of permanent damage to bones and joints. Case Presentation: Our experience of 3 such interesting cases showed the diagnostic dilemma involved in neonatal osteomyelitis. All 3 cases presented as cellulitis or subcutaneous abscess initially as x-ray changes appeared late (7-10 days after onset of disease). All the babies needed surgical debridement. The average duration of antibiotics given was 35.5 days. No residual sequelae were reported for up to 2 years. Conclusion: Neonatal osteomyelitis needs a high index of suspicion especially in late-onset neonatal sepsis or prolonged septicemia. This case series emphasizes the need for a low threshold for suspicion and early treatment to avoid permanent disability.

Systemic Antimicrobial Treatment of Chronic Osteomyelitis in Adults: A Narrative Review.

Chronic osteomyelitis in adults is a complex condition that requires prolonged and intensive antimicrobial therapy, but evidence on optimal selection and duration of antibiotics is limited. A review of PubMed and Ovid Embase databases was conducted to identify systematic reviews, meta-analyses, retrospective and randomised controlled trials (RCTs) on antibiotic treatment outcomes in adults with chronic osteomyelitis. Three main areas of interest were investigated: short-term versus long-term antibiotic therapy, oral versus parenteral antibiotic therapy, and combination antibiotic therapy with rifampicin versus without rifampicin. A total of 36 articles were identified and findings were synthesised using a narrative review approach. The available literature suffers from limitations, including a lack of high-quality studies, inconsistent definitions, and varying inclusion/exclusion criteria among studies. Most studies are open-labelled and lack blinding. Limited high-quality evidence exists that oral therapy is non-inferior to parenteral therapy and that shorter antibiotic duration might be appropriate in low-risk patients. Studies on the impact of rifampicin are inconclusive. Further well-designed studies are needed to provide more robust evidence in these areas.

Management of vertebral osteomyelitis in adults.

Vertebral osteomyelitis is a condition that predominantly affects older men with chronic comorbidities, such as diabetes, renal and hepatic failure, or immunosuppression. Symptoms develop insidiously and a high index of suspicion is required to diagnose the condition; this is achieved through serological testing and imaging. The mainstay of treatment is long-term antibiotic therapy, lasting a minimum of 6 weeks; however, surgical debridement with stabilisation is required when conservative treatment is proving ineffective and infection progresses. It is critically important that sufficient treatment is provided for those experiencing vertebral osteomyelitis, as not doing so could lead to severe neurological compromise and death.

Coating of bone implants with silica, hyperbranched polyethyleneimine, and gentamicin prevents development of osteomyelitis in a porcine model

The use of bone implants and prostheses has contributed to a revolution in modern medicine; however, in the beginning, not much was asked from the implant and prosthetic materials per se. Therefore, the next game-changer in orthopedic research will come from new material designs which for instance can aid in prevention of implant-associated bone infections. Here, we describe the development of a new sol-gel coating technique that can deliver an efficient antimicrobial surface coating on orthopedic implants. Gentamicin was stocked in a novel nanocomposite xerogel made from silica and hyperbranched polyethyleneimine. The xerogel was anchored inside a porous surface made by coating of bone implants with titanium microspheres. Thereby, only the small water-soluble gentamicin molecules diffused in an aqueous environment, i.e., just after surgical insertion and leaving behind a titanium scaffold for osseointegration. The novel xerogel coating prevented development of severe Staphylococcus aureus induced osteomyelitis in a porcine model, which untreated, replicated the pathology seen in stage 3A on the Cierny–Mader classification system for osteomyelitis in adults.

Use of Novel Strategies to Develop Guidelines for Management of Pyogenic Osteomyelitis in Adults

Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence. To construct a clinical guideline for pyogenic osteomyelitis management, with a new standard of evidence to resolve the gap between strength of recommendation and quality of evidence, through the use of a novel open access approach utilizing social media tools. This consensus statement and systematic review study used a novel approach from the WikiGuidelines Group, an open access collaborative research project, to construct clinical guidelines for pyogenic osteomyelitis. In June 2021 and February 2022, authors recruited via social media conducted multiple PubMed literature searches, including all years and languages, regarding osteomyelitis management; criteria for article quality and inclusion were specified in the group's charter. The GRADE system for evaluating evidence was not used based on previously published concerns regarding the potential dissociation between strength of recommendation and quality of evidence. Instead, the charter required that clear recommendations be made only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were drafted to discuss pros and cons of care choices. Both clear recommendations and clinical reviews were planned with the intention to be regularly updated as new data become available. Sixty-three participants with diverse expertise from 8 countries developed the group's charter and its first guideline on pyogenic osteomyelitis. These participants included both nonacademic and academic physicians and pharmacists specializing in general internal medicine or hospital medicine, infectious diseases, orthopedic surgery, pharmacology, and medical microbiology. Of the 7 questions addressed in the guideline, 2 clear recommendations were offered for the use of oral antibiotic therapy and the duration of therapy. In addition, 5 clinical reviews were authored addressing diagnosis, approaches to osteomyelitis underlying a pressure ulcer, timing for the administration of empirical therapy, specific antimicrobial options (including empirical regimens, use of antimicrobials targeting resistant pathogens, the role of bone penetration, and the use of rifampin as adjunctive therapy), and the role of biomarkers and imaging to assess responses to therapy. The WikiGuidelines approach offers a novel methodology for clinical guideline development that precludes recommendations based on low-quality data or opinion. The primary limitation is the need for more rigorous clinical investigations, enabling additional clear recommendations for clinical questions currently unresolved by high-quality data.

The management of chronic osteomyelitis in adults: outcomes of an integrated approach

ABSTRACT BACKGROUND: This study presents the outcomes of the management of chronic osteomyelitis of the appendicular skeleton according to an integrated approach at a dedicated bone infection unit in South Africa. METHODS: A retrospective record review identified 80 patients who were treated between January 2016 and December 2018. RESULTS: Sixty patients (75%) presented with fracture-related infections, 17 patients (21%) developed chronic osteomyelitis following haematogenous spread and three (4%) from contiguous wounds. According to the Cierny and Mader classification, 21 patients presented with anatomical type I, 14 with type II, 24 with type III and 21 with type IV chronic osteomyelitis. Positive microbial cultures were obtained in 63 (79%) cases. Follow-up for the cohort ranged from 1 to 29 months, with a mean follow-up of 10.4 months. The overall complication rate for the cohort was 6% and included sterile drainage from the surgical site after management with bioactive glass (S53P4), refracture after hardware removal, and development of non-union. Five patients experienced recurrence after the initial procedure to eradicate infection, resulting in an overall resolution rate of 94%. CONCLUSION: Using single-stage surgeries and tailored dead space management strategies according to a comprehensive integrated approach developed in South Africa, results comparable to international literature can be achieved. Level of evidence: Level 4. Keywords: chronic osteomyelitis, dead space management, bioactive glass, Lautenbach technique

Advances in clinical diagnosis and treatment of chronic osteomyelitis in adults

To review the progress of clinical diagnosis and treatment of chronic osteomyelitis in adults. The literature related to chronic osteomyelitis in recent years was extensively reviewed, and the clinical diagnosis and treatment methods were summarized. Clinical characteristics and laboratory examination can help to diagnose chronic osteomyelitis in adults. Pathogenic identification is the basis for choosing antibiotics. Diagnostic imaging is specific. The treatment includes systemic treatment and local treatment, and the local treatment is the key to radical cure. The diagnosis of chronic osteomyelitis in adults should be made as early as possible. According to the anatomical and physiological classification of the patients, the appropriate treatment plan should be made.

Dalbavancin versus standard of care for the treatment of osteomyelitis in adults: A retrospective matched cohort study

ObjectiveTo assess the safety and effectiveness of dalbavancin compared to standard of care (SOC) in the treatment of osteomyelitis in adults. MethodA retrospective cohort study of patients with osteomyelitis due to S. aureus treated with dalbavancin was conducted. Patients who received at least 2 doses of dalbavancin for the treatment of osteomyelitis between January 1, 2015 to January 31, 2018 in a single center in Texas, USA were identified and matched in 1:1 ratio with controls who received SOC. The primary efficacy outcome was the clinical success at the end of treatment. Secondary efficacy outcome was the clinical success continued for at least 3 months after the completion of the antimicrobial therapy. ResultsDuring study period, 21 patients received dalbavancin for the treatment of osteomyelitis; however, only 11 patients were eligible for inclusion and matched to 11 others who received SOC. Primary outcome was achieved in all 11 patients who received dalbavancin and all those patients subsequently attained the secondary outcome. In SOC group, primary outcome occurred in 82% (9/11) of patients in which 8 out of 9 patients subsequently achieved the secondary outcome. No adverse reaction noted in either group. ConclusionDalbavancin appears to be safe and effective for the management of osteomyelitis in adults. Further studies are needed to confirm these findings.

Adult pseudo-tumor-like subacute osteomyelitis

Hematogenous osteomyelitis in adults is rare, and its subacute form is exceptional after the age of 20. It' is usually clinically latent which explains the difficulty of the diagnosis. The first differential diagnosis is bone tumors. It is known for its poor clinical and biological presentation despite a rich radiological aspect. Magnetic resonance imaging (MRI) is the examination of choice to confirm the diagnosis. The main differential diagnosis are primary and secondary bone tumors. The treatment is based on surgery and precise antibiotic therapy. Our patient is 52 years old who had pain in his left thigh, a discrete inflammatory syndrome without fever. He underwent standard X-ray, scintigraphy, and MRI, leading to finding an intraosseous lytic process with rupture of the cortical bone. The diagnosis of staphylococcal osteomyelitis was confirmed thanks to surgical biopsy and bacteriological sample, and his treatment was completed with specific antibiotic therapy.

Surgical Treatment and Outcomes of Calcaneal Osteomyelitis in Adults: A Systematic Review.

Introduction: Calcaneal osteomyelitis is an uncommon and challenging condition. In this systematic review we aim to analyse the outcomes from concomitant use of bone debridement and soft tissue management for patients diagnosed with calcaneal osteomyelitis.Materials & Methods: A complete computerised and comprehensive literature search of Pubmed and Cochrane database was undertaken from January 2000 to October 2018. During the review, studies were screened for information about the surgical and antimicrobial treatment, the complications, the reinfection rate and the functional outcome of patients with calcaneal osteomyelitis.Results: Of the 20 eligible studies included, seven (35%) described bone treatment only, six (30%) soft tissue treatment only, five (25%) soft tissue and bone treatment, and two (10%) focused on prognostic factors and differences in outcomes between diabetic and non-diabetic patients.In the studies with bone treatment only, infection recurrence ranged from 0 to 35% and the amputation rate from 0 to 29%. If soft tissue coverage was also needed, both the reinfection rate and amputation rate ranged from 0 to 24%. Studies presenting the functional status generally showed preservation or even improvement of the preoperative ambulatory status.Conclusion: Calcaneal osteomyelitis is difficult to treat. A multidisciplinary approach involving orthopaedic surgeons, plastic surgeons and infectious disease physicians is preferred. The heterogenicity of studies has hindered the development of agreed treatment protocols, which would be useful in clinical practice.

Systemic antibiotic treatment of chronic osteomyelitis in adults.

Chronic osteomyelitis is a difficult to treat infection of the bone, which requires a combined medical and surgical approach and often persists intermittently for years, with relapses and failures. The optimal type, route of administration, and duration of antibiotic treatment remain controversial, and the emergence of multi-drug resistant organisms poses major therapeutic challenges. Identification of the causative agent and subsequent targeted antibiotic treatment has a major impact on patients' outcome. In this review, we summarize which intravenous and oral antibiotics are the best options available for the treatment of chronic osteomyelitis, according to specific aetiologies.

Pyogenic Vertebral Column Osteomyelitis in Adults: Analysis of Risk Factors for 30-Day and 1-Year Mortality in a Single Center Cohort Study.

Study DesignRetrospective cohort study.PurposeTo describe our experience in the management and outcomes of vertebral column osteomyelitis (VCO), particularly focusing on the risk factors of early and late mortality.Overview of LiteraturePrevious reports suggest a global increase in spinal column infections highlighting significant morbidity and mortality. To date, there have been no reports from our local population, and no previous report has assessed the potential relationship of frailty with mortality in a cohort of patients with VCO.MethodsWe reviewed 76 consecutive patients with VCO between 2009 and 2016 in Waikato Hospital, New Zealand. Demographic, clinical, microbiological, and treatment data were collected. Comorbidities were noted to calculate the modified Frailty Index (mFI). Mortality at 30 days and 1 year was recorded. Univariate and multivariate analyses were used to identify the predictors of mortality.ResultsThe mean age of patients was 64.1 years, with 77.6% being male. Most patients presented with axial back pain (71.1%), with the lumbar spine most commonly affected (46%). A mean of 2.1 vertebral bodies was involved. Methicillin-sensitive Staphylococcus aureus was the most common organism of infection (35.5%), and 15.8% of patients exhibited polymicrobial infection. Twenty patients (26.3%) underwent surgical intervention, which was more likely in patients with concomitant spinal epidural abscess (odds ratio [OR], 4.88) or spondylodiscitis (OR, 3.81). Mortality rate was 5.2% at 30 days and 22.3% at 1 year. The presence of frailty (OR, 13.62) and chronic renal failure (OR, 13.40) elevated the 30-day mortality risk only in univariate analysis. An increase in age (OR, 1.07) and the number of vertebral levels (OR, 2.30) elevated the 1-year mortality risk in both univariate and multivariate analyses.ConclusionsAlthough the mFI correlated with 30-day mortality in univariate analysis, it was not a significant predictor in multivariate analysis. An increase in age and the number of levels involved elevated the 1-year mortality risk.

Dalbavancin for the Treatment of Osteomyelitis in Adult Patients: A Randomized Clinical Trial of Efficacy and Safety.

BackgroundOsteomyelitis is a challenging infection that can involve 4–6 weeks of intravenous (IV) antibiotics. Dalbavancin, approved for acute bacterial skin and skin structure infections, has potent activity against gram-positive pathogens. This study assessed the efficacy and safety of dalbavancin as a 2-dose regimen for osteomyelitis.MethodsThis study was a randomized, open-label, comparator-controlled trial in adults with a first episode of osteomyelitis defined by clinical symptoms, radiologic findings, and elevated C-reactive protein. Patients were randomized 7:1 to dalbavancin (1500 mg IV on days 1 and 8) or standard of care (SOC) for osteomyelitis (oral or IV) per investigator judgment for 4–6 weeks. The primary endpoint was clinical response at day 42, defined as recovery without need for additional antibiotics in the clinically evaluable (CE) population. Clinical response was also assessed at day 21, 6 months, and 1 year.ResultsEighty patients were randomized to dalbavancin (n = 70) or SOC (n = 10). All had baseline debridement; Staphylococcus aureus was the most common pathogen (60% of patients). Clinical cure at day 42 was seen in 65/67 (97%) and 7/8 (88%) patients in the dalbavancin group and SOC group in the CE population, respectively. Clinical response was similar in the dalbavancin group at day 21 (94%), 6 months, and 1 year (96%). Treatment-emergent adverse events occurred in 10 patients in the dalbavancin group; no patient discontinued treatment due to an adverse event.ConclusionsA 2-dose regimen of weekly dalbavancin is effective and well tolerated for the treatment of osteomyelitis in adults.Clinical Trials RegistrationNCT02685033.

Dalbavancin for the management of gram-positive osteomyelitis: Effectiveness and potential utility

Dalbavancin is approved by the US Food and Drug Administration for the treatment of acute bacterial skin and skin structure infections. It has promising pharmacokinetic/pharmacodynamic profiles in treating bone infections and safety data after multiple weekly dosing. The primary objective of this study is to describe the effectiveness and tolerability of dalbavancin in the treatment of osteomyelitis in adults. This study is a multicenter retrospective review, designed to identify patients with osteomyelitis who were treated with dalbavancin. Thirty-six patients with confirmed diagnosis of osteomyelitis who received dalbavancin were identified. Thirty-one patients met inclusion criteria for evaluation of clinical success at the end of the antibiotic course and 3 months after the completion of therapy. Twenty-eight (90%) patients achieved clinical success and there were no adverse events noted. Dalbavancin appears to be safe and effective in the treatment of osteomyelitis. More studies are needed to validate these findings.

Successful management of intramedullary nail associated infection with reaming and antibiotic cement beads/rod

Objective To assess the efficacy of using reaming and antibiotic cement beads/rod for intramedullary nail as-sociated infection. Methods Data of 12 patients with intramedullary infection of tibia or femur following intramedullary nailing from October 2014 to April 2016 were retrospectively analyzed. There were 10 men and 2 women aged from 19 to 63 years old with an average age of 39.2 years. In 5 cases the disease was localized in the femur with one case of nonunion, and in other 7 cases the disease was localizedin the tibia with two cases of nonunion. The initial injury included closed fracture in 8 patients and open fracture in 4 patients which were all Gustilo-AndersonⅡ. According to the Cierny-Mader classification of adult osteomyelitis, 6 cases were typeⅠ (medullary osteomyelitis), 4 cases were type Ⅰcombined with type Ⅲ (medullary and localized osteomyelitis), and 2 cases were typeⅠ combined with type Ⅳ (medullary and diffuse osteomyelitis). Surgical technique included removal of the intramedullary nailand reaming and irrigation of the medullary canal to remove intramedullary debris. The drainage sinus and soft tissues abscess were excised if existed. An local or enbloc resection for the infected or necrotic bone was performed if there was lo-cal or diffuse infection in the fracture sites. Ilizarov technique was performed for segment bone defect. The bone union was ob-served in nine patients and stable nonunion in one. Antibiotic PMMA beads were inserted into intramedullary canal for these ten cases after debridement, and the antibiotic beads were removed approximately 12-14 days after implantation. The antibiotic ce-ment rod was inserted into the medullary canal to provide stabilization in the other 2 cases. All the patients received intravenous antibiotics systemically for three weeks, and followed by three weeks of oral antibiotics. Results At a mean follow-up period of 23.5 months (range, 15-33 months), no recurrence of infection was observed. There were 3 cases of nonunions. One case of tibial nonunion had been achieved union 10 months after insertion of an antibiotic cement rod. One with stable nonunion of tibia was treated with antibiotic PMMA beads, and enbloc resection for the infected bone was performed after the extension of infection had been narrowed at the nonunion. 6 cm of bone defect was treated with bone transport and then union was obtained 16 months after operation. The third case was infected nonunion in the femur with 4 cm bone defect after debridement. The femur was shortened and temporarily stabilized with the intramedullary antibiotic cement rod. The rod was removed three months after the operation, and then the femur was lengthened. The docking site and the regeneration area were healed 12 months after the lengthening opera-tion. Conclusion The clinical results shows that reaming and antibiotic cement beads/rod appears an effective and safe alterna-tive for management of intramedullary nail associated infection of the tibia and femur. Key words: Femur; Tibia; Infection; Fracture fixation, intramedullary

Acute exposure of white-tailed deer cortical bone to Staphylococcus aureus did not result in reduced bone stiffness.

Staphylococcus aureus (S. aureus) is the main source of osteomyelitis in adults. The end-result of untreated osteomyelitis is bone necrosis and distraction of bone structure. While bone tissue can heal and remodel its structure to ameliorate its mechanical properties, so far no study has tested the mechanical properties of cortical bone tissue exposed to S. aureus. With the increase usage of bone banks as a source of bone graft supply, it is important to screen for any possible pathology that may affect the bone graft success to function normally in the receiving patient. This study tested the effect of acute exposure to S. aureus on cortical bone stiffness. We have postulated that the incubation of cortical bone with S. aureus for 48 h will result in a significant decrease in bone stiffness. Sixty-five bone cubes (2 × 2 × 2 mm) were prepared from the cranial and caudal aspects of four white-tailed deer mid-diaphysis humeri. First, all bone samples were tested to determine their stiffness in the three principle orientations (axial, radial and transverse). Next, bone samples were incubated for 48 h with S. aureus (32 cubes, experimental group) or with sterile distilled water (33 cubes, control group). Finally, all cubes were mechanically tested again and each stiffness value was compared to the original value obtained from the same cube. Our results revealed that overall, acute exposure to S. aureus did not significantly decrease bone stiffness and thus our working hypothesis could not be supported. Therefore, our findings support the current tissue collection screening methods employed by bone-graft banks.