title: Differences in the Clinical Outcome of Osteomyelitis by Treating Specialty: Orthopedics or Infectology.
abstract: Osteomyelitis is a heterogeneous infection with regard to etiology and treatment, and currently no single management protocol exists. Management of the condition is typically an interdisciplinary approach between orthopedics and infectious disease; however, the orthopedist is often the person who manages treatment. The aim of the study was to determine differences in the outcome of osteomyelitis according to its treating specialty and to identify factors associated with the recurrence of the disease. An ambispective cohort study of 129 patients with osteomyelitis was conducted and the proportions for qualitative variables and central tendency and dispersion measures for quantitative variables were calculated; the latter were tested for normality using the Shapiro-Wilk test. A bivariate analysis was conducted with measures of association based on the chi square test and crude relative risk. A logistic regression model was applied and statistical significance was set at p < 0.05, including the model of relevant clinical variables that fit the Hosmer-Lemeshow test. We found that 70% of patients were treated either by orthopedics or infectious disease. Patients who were treated by an orthopedist alone presented a greater risk of relapse or reinfection (RR = 4.6; 95% CI 2.3;8.9). Risk factors of osteomyelitis recurrence as determined in the regression model included the following: age of 57 years or older (RR = 1.3; 95% 0.3;5.2), long bones (RR = 1.9; 95% CI 0.5;7.1), fracture (RR = 5.0; 95% CI 0.4;51.4), monotherapy (RR = 3.0; 95% CI 0.6;14.5), receiving less than 4 weeks of antibiotics (RR = 1.5; 95% CI 0.2;10.1), inadequate treatment (RR = 3.1; 95% CI 0.4;20.1), and receiving orthopedics treatment (RR = 5.5; 95% CI 1.6;18.2). Most patients evaluated jointly by orthopedics and infectious disease received adequate treatment for osteomyelitis and had fewer relapses.
authors.affiliation: Department of Epidemiology, Universidad CES, Medellín, Antioquia, Colombia.
authors.forename: Carolina
authors.initials: C
authors.lastname: Arias Arias
authors.affiliation: Department of Epidemiology, Universidad CES, Medellín, Antioquia, Colombia.
authors.forename: Maria Carolina
authors.initials: MC
authors.lastname: Tamayo Betancur
authors.affiliation: Department of Infectious Diseases, Clínica Medellín, Medellín, Antioquia, Colombia.
authors.forename: Miguel Alejandro
authors.initials: MA
authors.lastname: Pinzón
authors.affiliation: Department of Epidemiology, Universidad CES, Medellín, Antioquia, Colombia.
authors.forename: Doris
authors.initials: D
authors.lastname: Cardona Arango
authors.affiliation: Department of Infectious Diseases, Fundación Clínica del Norte, Bello, Antioquia, Colombia.
authors.forename: Cesar Antonio
authors.initials: CA
authors.lastname: Capataz Taffur
authors.affiliation: Department of Orthopedics, Nueva Clínica Sagrado Corazón, Medellín, Antioquia, Colombia.
authors.forename: Edgar
authors.initials: E
authors.lastname: Correa Prada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D055552:Infectious Disease Medicine; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D010019:Osteomyelitis / Q000628:therapy*; D012008:Recurrence; D012306:Risk; D016896:Treatment Outcome; D055815:Young Adult