Preferred Management of Pressure Ulcer-Related Pelvic Osteomyelitis

Several overlapping opinions were identified among orthopedic surgeons regarding the optimal diagnostic approach and management of pressure ulcer-related pelvic osteomyelitis. These study results were published in Open Forum Infectious Diseases.

Researchers used an 18-question questionnaire with Likert-type scale responses to survey orthopedic surgeons about the diagnosis and management of patients with pressure ulcer-related pelvic osteomyelitis. The questionnaire was distributed to members of the Musculoskeletal Infection Society, the European Bone and Joint Infection Society, and the European Society of Clinical Microbiology and Infectious Diseases Study Group for Implant-Associated Infections.

In total, 41 orthopedic surgeons completed the questionnaire. Of the survey respondents, 29 had between 15 and 24 years of experience in clinical practice, the majority were primarily from Europe (n=18) and the United States (n=10), and 26 were employed at tertiary hospital or academic hospitals.

For the diagnosis of pressure ulcer-related pelvic osteomyelitis, survey results indicated microbiological and histologic findings from bone samples as high priority and culture-positive superficial swabs as very low priority (P <.0001). Respondents also indicated palpable bone as a high priority for diagnosis, though primarily without the presence of periosteal covering.

Respondents agreed that recurrent osteomyelitis was an indication for prolonging antimicrobial therapy. However, there was no consensus on the appropriate duration of therapy in the event that soft tissue coverage could not be achieved after debridement, or if no debridement were planned.

In managing patients with pressure ulcer-related pelvic osteomyelitis, 34 respondents indicated receiving input from an infectious disease specialist in all cases.

Respondents primarily indicated source control for sepsis as the most influential factor for recommending patients for surgical intervention (n=24). Other influential factors included abscess/collection, followed by wound closure. Local or regional primary tissue transfer was the most preferred wound closure technique among the respondents.

Further analysis was performed after respondents were stratified by experience in treating patients with pressure ulcer-related pelvic osteomyelitis within the previous year. Respondents without experience in the previous year (n=8) were less likely to recommend patients for early surgical intervention. Respondents with experience within the previous year (n=31) were more likely to recommend local or regional tissue transfer for primary wound closure.

Limitations of this study include the small sample size and potential selection bias.

For patients with pressure ulcer-related pelvic osteomyelitis, “This represents a starting point for future discussion about management approaches, and for formulating clinical trial questions to ultimately inform guidelines for management,” the researchers concluded.

This article originally appeared on Infectious Disease Advisor