title: The role of active immunization therapy as preoperative treatment for chronic osteomyelitis.
abstract: BACKGROUND
  This retrospective study was performed to assess the effectiveness of active immunostimulation therapy with bacterial immunotherapy (BIT) in treatment for chronic osteomyelitis (COM).
  
  
  METHODS
  We analyze 154 patients affected by COM and treated with BIT from 1995 to 2009 at our Institution. Using Cierny and Mader classification, patients were divided according to their clinical status and anatomic nature of septic process. The data were analyzed considering several confounding factors, such as antibiotic therapy and hyperbaric oxygen therapy combined with the administration of BIT. According to clinical and radiographic parameters, patients were considered as unchanged, improved, or healed.
  
  
  RESULTS
  After a mean follow-up of 40.4 months (median 38 months), healing was achieved in 41.6 % of cases. Multivariate statistical analysis showed that patient's clinical status is the most important prognostic factor of responding (p < 0.0005) and healing (p = 0.008) after therapy. The best healing rate (62 % of cases) was achieved in patients with a normal clinical condition (Cierny-Mader group A); it was worse (20 % of cases) in those patients with a compromised clinical status (Cierny-Mader group B). There was no healing case in group C.
  
  
  CONCLUSIONS
  The results show the effectiveness of BIT in treatment of patients affected by COM with uncompromised clinical status. The use of this therapy must be assessed critically in patients with alterations in clinical conditions.
authors.affiliation: Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy, matteofosco27@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Fosco
authors.forename: G
authors.initials: G
authors.lastname: Gualdrini
authors.forename: R
authors.initials: R
authors.lastname: Ben Ayad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications; D016667:Bacterial Capsules / Q000276:immunology*; D001428:Bacterial Vaccines / Q000276:immunology / Q000627:therapeutic use*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000150:complications; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013211:Staphylococcus aureus / Q000276:immunology*; D016896:Treatment Outcome; D014611:Vaccination; D014946:Wound Infection / Q000188:drug therapy / Q000276:immunology / Q000628:therapy; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001428:Bacterial Vaccines