title: Outcomes of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Infections Limited, P.S., Tacoma, Washington, USA. alantice@idlinks.com
authors.forename: Alan D
authors.initials: AD
authors.lastname: Tice
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Hoaglund
authors.forename: David A
authors.initials: DA
authors.lastname: Shoultz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002437:Cefazolin / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology / Q000401:mortality* / Q000473:pathology; D017063:Outcome Assessment, Health Care; D010406:Penicillins / Q000627:therapeutic use; D016491:Peripheral Vascular Diseases / Q000150:complications; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000473:pathology; D013211:Staphylococcus aureus; D016019:Survival Analysis; D014640:Vancomycin / Q000627:therapeutic use; D014861:Washington / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D014640:Vancomycin; D002443:Ceftriaxone; D002437:Cefazolin