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Outcomes of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy

  • Alan D Tice
    Correspondence
    Requests for reprints should be addressed to Alan D. Tice, MD, Outpatient Parenteral Antimicrobial Therapy Outcomes Registry, 6240 Tacoma Mall Boulevard, Suite 104, Tacoma, Washington 98409, USA
    Affiliations
    Infections Limited, P.S. (ADT, PAH), Tacoma, Washington, USA

    Outpatient Parenteral Antimicrobial Therapy Outcomes Registry (ADT, PAH), Tacoma, Washington, USA
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  • Pamela A Hoaglund
    Affiliations
    Infections Limited, P.S. (ADT, PAH), Tacoma, Washington, USA

    Outpatient Parenteral Antimicrobial Therapy Outcomes Registry (ADT, PAH), Tacoma, Washington, USA
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  • David A Shoultz
    Affiliations
    PPD Development (DAS), Wilmington, North Carolina, USA

    Department of Epidemiology (DAS), University of Washington, Seattle, Washington, USA
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      Abstract

      Purpose

      To examine the effects of diabetes, vascular disease, age, and antimicrobial therapy on clinical outcomes, including amputation rates, in patients with osteomyelitis treated in the outpatient setting.

      Methods

      We performed a retrospective chart review of patients treated with intravenous antimicrobial therapy for osteomyelitis at an outpatient infectious diseases practice. All patients were followed for at least 6 months.

      Results

      Four hundred and fifty-four patients qualified for inclusion, with follow-up information available for up to 10 years. One hundred and thirty-nine patients (31%) had recurrences and 27 (6%) had amputations. Of the recurrences, 108 (78%) occurred within 6 months and 132 (95%) within 1 year. In univariate analyses, peripheral vascular disease, diabetes, and the combination were all associated with the risk of recurrence; age (>70 years) was not. For osteomyelitis due to Staphylococcus aureus, the relative risk of recurrence, using a Cox regression model, was 0.8 for ceftriaxone (95% confidence interval [CI]: 0.4 to 1.5; P = 0.53), 1.1 for cefazolin (95% CI: 0.5 to 2.2; P = 0.80), and 2.5 for vancomycin (95% CI: 1.1 to 5.6; P = 0.04), as compared with the use of a penicillinase-resistant penicillin.

      Conclusion

      Diabetes and peripheral vascular disease are important factors in determining the prognosis of patients with osteomyelitis, but age is not. Almost all recurrences of osteomyelitis occur within 1 year. Recurrence rates with osteomyelitis associated with S. aureus appear to be higher with the use of vancomycin, whereas ceftriaxone and cefazolin appear to be similar to penicillinase-resistant penicillins.
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