Osteomyelitis in Late-Stage Pressure Sore Patients: A Retrospective Analysis

TL;DR

This study examines how often osteomyelitis occurs in patients with advanced pressure sores and finds that it doesn't necessarily lead to worse outcomes.

Contribution

The study provides new insights into the prevalence and clinical impact of osteomyelitis in late-stage pressure sore patients.

Findings

Osteomyelitis was detected in 39% of initial biopsies and increased to 70% by the third debridement.

Patients with initial osteomyelitis had higher infection markers upon admission.

No strong evidence was found linking osteomyelitis to worse clinical outcomes.

Abstract

Background: Late-stage pressure sore (PS) patients are particularly susceptible to osteomyelitis (OM), as bony prominences commonly constitute the focal point of the ulcer. There are lack of data regarding the associated factors and the clinical relevance of this diagnosis in the context of PS treatment. Methods: This retrospective analysis investigated the clinical characteristics, blood markers indicative of infection in PS patients, and development of histologically evident OM. A total of 125 patient were included from 2014 to 2019. The patient records were especially scanned for histological diagnosis of OM. Results: OM was detected in 39% (37/96) of the samples taken during the index procedure. OM prevalence increased to 56% (43/77) at the second and 70% (41/59) at the third debridement. Therefore, the diagnosis of OM was acquired during treatment in 35 cases. Patients diagnosed with initial OM presented significantly higher blood markers, indicative of infection upon admission. Only patients with consistent OM (three positive biopsies) showed higher flap revision rates. Conclusion: This study found no compelling evidence linking OM to worse clinical outcomes in PS patients. In the absence of elevated inflammatory markers, reducing bone biopsy frequency and adopting a less aggressive bone debridement approach may help prevent OM in PS patients.

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