Osteoarticular Infections: Epidemiological, Clinical and Therapeutic Aspects at the Orthopaedic Traumatology Department of CHU Ignace Deen, Conakry

Keywords

Osteo Articular Infections; Epidemiology; Clinical; Treatment; Ignace Deen.

Abstract

Introduction: Osteo Articular Infections (OAI) refer to all musculoskeletal disorders affecting bones and/or joints caused by the penetration of a pathogenic microorganism into the human body. The aim of this study was to manage IOA in our department.

Patients and methods: We conducted an observational study covering a six-year period, January 2017 December 2022. We included patients and records of hospitalized patients treated and followed up for HAI.

Results: HAIs accounted for 2.9% of hospitalizations and were dominated by chronic osteomyelitis and osteitis. The average age was 29.4 years, with a male predominance of 64.7% and a sex ratio of 1.83. Septic wounds (95.6%), pain (94.1%) and fistulas (92.6%) were the most common signs. Radiographic signs were dominated by sequestration (67.6%). ECB performed in 100% of cases revealed Staphylococcus aureus in 77.9%, with sensitivity to β-lactam antibiotics (54.4%) and eight cases of absence of germs. At final follow-up, we recorded a very good result in six patients (31.6%), a good result in eight patients (42.1%) and a poor result in five patients (26.3%).

Conclusion: HAIs are common, and are diagnosed clinically, radiologically and microbiologically. Good results can be achieved with appropriate treatment.

Citation

Camara T, Aboud A, Diallo MS, Bangoura IS, Barry MM, et al. (2024) Osteoarticular Infections: Epidemiological, Clinical and Therapeu tic Aspects at the Orthopaedic-Traumatology Department of CHU Ignace Deen, Conakry: A Case Report. SM J Orthop 7: 6.

INTRODUCTION

Osteo Articular Infections (OAI) refer to all musculoskeletal disorders affecting bones and/or joints, caused by the penetration of a pathogenic micro-organism into the human body [1]. They are frequent, and despite advances in radiological explorations (standard radiography, ultrasound, CT scan, magnetic resonance imaging, scintigraphy), they still pose problems, both diagnostic, due to the insufficient contribution of microbiology, and therapeutic, in the absence of national guidelines for optimal first-line antibiotic therapy [2]. While clinical diagnosis is generally straightforward, microbiological diagnosis is often difficult because of the urgency of initiating antibiotic treatment. Puncture of a joint or para-articular collection is the key examination for microbiological documentation, and should be combined with blood cultures [3]. Treatment is necessarily complex, involving a gold standard of aggressive debridement, bone stabilization, coverage of the exposed area and appropriate antibiotic therapy. Improperly performed, these procedures can result in significant functional sequelae and, in some cases, be life-threatening [1].

PATIENTS AND METHODS

This was a six-year observational and analytical study, January 2017 to June 31, 2022. We targeted all patients and patient records with chronic infected wound and lumbar spine pain. The study population consisted of patients and records of patients received and hospitalized, for osteoarticular infection. We included all records of patients hospitalized, treated and followed-up for osteoarticular infection, and all patients hospitalized, treated and followed-up for osteoarticular infection who agreed to participate in the study. Data collected included: frequency, age, sex, portal of entry, bones involved, surgical procedures performed, causative organisms, antibiotic susceptibility, assessment of therapeutic results.

Radiography of the infected limb segment (face/profile) was systematically performed on all patients. This revealed the various anatomopathological lesions and their location. Biological tests enabled us to identify germs in certain cases, but also to confirm the infection.

1) For patients with osteomyelitis and osteitis, the principle was to perform debridement and sampling for cytobacteriological analysis.

2) For patients with spondylodiscitis, the principle was to perform level decompression and sampling for cytobacteriological analysis.

3) The Chi2 test was used to test for an association between the occurrence of HAI and certain factors (age, sex, surgical history, vices, defects). The significance threshold was set at p ˂ 0.05.

RESULTS

Out of a total of 2,350 hospitalizations, we recorded 68 cases of osteoarticular infections, representing a frequency of 2.9%. The under-20 age group was the most affected, with an average age of 29.4 ± 20.6 years and extremes of 3 and 79 years (Table 1).

Table 1: IOA frequency by age group.

Mean Age: 29.4 ± 20.6 years.

Males accounted for 64.7% of cases, with a sex ratio of 1.83. The portal of entry was cutaneous in 83.8% of cases. The bones most frequently affected were the tibia (51.5%) and the femur (30.9%) (Table 2).

Table 2: Distribution of patients by affected bone.

The surgical procedures most frequently used were debridement, sampling for antibiotic susceptibility testing, sequestrectomy, fistulectomy and abundant lavage in 61.8% of cases (Table 3-5) (Figure 1-4).

Table 3: Distribution of patients according to pus ECB results.

Table 4: Distribution of patients according to antibiogram results.

Table 5: Patient distribution according to Monka M, et al. [8] assessment criteria.

Figure 1: Preoperative clinical image of the left leg.

Figure 2: X-ray of the left leg.

Tibia: Bone sequestration in the upper 1/3.

Fibula: No bony lesions.

Figure 3: Intraoperative image of the leg after trepanation, sequestrectomy and washing with sequestrates.

Figure 4: Image of the left leg after 3 months with complete healing and control X-ray.

DISCUSSION

We conducted a descriptive and analytical observational study to collect data on patients with OAIs and their management. During this study, we recorded 68 cases of osteoarticular infection, representing a frequency of 2.9%. Houzou P, et al. [4] in 2017 in Togo reported 86 cases of osteoarticular infection. This frequency in our study could be explained by the delay in appropriate initial treatment. The average age of patients was 29.4 ± 20.6 years, with extremes of 3 and 79 years. Nalcouma SI, et al. [5] found an average age of 17.7 years, with extremes of 2 and 60 years. 

Our result could be explained by the fact that children and young adults suffer many neglected traumas. We found a male predominance of 64.7%, with a sex ratio (M/F) of 1.83. Angala ARL, et al. [6] Grammatico-guillon L, et al. [7] also made the same finding, reporting a predominance of male patients with sex ratios of 1.2 and 1.54 respectively. This result could be explained by boys’ turbulence, which exposes them more to trauma, but also by the fact that most HAIs are linked to the many road traffic accidents to which men are most exposed, and to their poor compliance with medical instructions.

Topographically, the pelvic limb was more affected than the thoracic limb. The tibia was the most frequent site of bone involvement, followed by the femur. This result is comparable to that of Monka M, et al. [8] between January 2009 and December 2015 at Brazzaville University Hospital, who observed in their study that the tibia was the most frequent site of bone involvement (n = 11), followed by the femur (n = 5). Taarit CB, et al. [9] in 2002 and Badaoui L, et al. [10] in 2014 found 78% and 85% lumbar localization respectively in infectious spondylodiscitis cases [9,10]. This finding is in line with data in the literature demonstrating that osteitis can involve all localisations of the musculoskeletal system, while osteomyelitis corroborates with the expression “near the knee, far from the elbow”) [11,12].

Staphylococcus aureus was the most isolated germ in our study. This result is in line with data from several authors in the literature, who show that Staphylococcus aureus is the germ most frequently found in HAIs [11,13,14]. Germs were most often susceptible to β-lactams (54.4%) and glycopeptides (44.1%). In 2005, Kouamé BD, et al. [15] at the Yopougon University Hospital used a bi-antibiotic therapy combining a 3rd generation cephalosporin and an aminoglycoside in 60% of cases. This may be justified by the fact that β-lactam penetration of bone and synovial fluid is good. A good result was recorded in 8 patients (42.1%), a very good result in 31.6% and complications in 26.3% of patients, i.e. a poor result. Monka M, et al [8] noted a very good result in 10 patients, a good result in 6 patients and 1 case of death, i.e. a poor result.

CONCLUSION

Osteoarticular infections are becoming less frequent in our context. They are dominated by osteomyelitis and chronic osteitis. They occur preferentially in the tibia, and Staphylococcus aureus remains the most frequently incriminated germ. Diagnosis is based on clinical, radiological and microbiological evidence. Management is rarely medical or, in exceptional cases, surgical, but most often medical-surgical.

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