Chronic osteomyelitis: Comparison of outcome following the use of antibiotic impregnated beads and gentamycinsaline solution after sequestrectomy

Abstract

Background: Chronic osteomyelitis (COSM) is a common disease in developing countries. Complete cure of the disease is difficult due to its high  recurrent rate. Sequestrectomy and debridement in addition to parenteral antibiotics is essential in the treatment of the disease. Local deposition of antibiotics has been shown to be effective in eradicating residual bacteria. The aim of this study was to compare the outcome of treatment following the use of antibiotic beads vs gentamycin-saline solution as local antibiotic delivery after sequestrectomy.
Method: A prospective study carried out between April 2014 and March 2016. Each patient was followed up for a year.
Results: Sixty-seven patients were recruited during the study period, 46 males and 21 females (M:F=2.2:1). The mean age was 22 ± 8.2 years, (range = 4 to 72 years). COSM was most common in the age group 11-20 years, n=37 (55.2%), the disease was commonest among patient with genotype SS, n=25 (37.3%). The commonest aetiology was acute haematogenous osteomyelitis, n=43 (64.2%). Tibia was the commonest bone involved, n=34 (50.7%). The commonest organism isolated from the sinus tract and sequestrum was Staphylococcus aureus, n=32 (56.2%), and n=34(56.7) respectively. Antibiotic beads were used in 27 (40.3%) patients after sequestrectomy with one recurrence, while 40 (59.7%) patients had gentamycin-saline instillation after sequestrectomy with two recurrences.
Conclusion: Chronic osteomyelitis is still common in Nigeria, the organism cultured from sinus tract and the sequestrum is the same in most cases. Instillation of gentamycin-saline solution after sequestrectomy is as good as using antibiotic beads after sequestrectomy.