Outcome and Predictors of Treatment Failure in Chronic Osteomyelitis Using Bioactive Glass Granules and Putty Formulations
Adriana Macedo Dell’Aquila,
Gabriela Nagy Baldy dos Reis,
Gabriel Trova Cuba,
Walter Hamilton de Castro Targa,
José Carlos Bongiovanni,
Thomas Stravinskas Durigon,
Mauro José Salles,
Fernando Baldy dos Reis
Affiliations
Adriana Macedo Dell’Aquila
Infectious Diseases Discipline, Department of Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-900, Brazil
Gabriela Nagy Baldy dos Reis
Department of Orthopedics and Traumatology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-900, Brazil
Gabriel Trova Cuba
Infectious Diseases Discipline, Department of Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-900, Brazil
Walter Hamilton de Castro Targa
Institute of Orthopedics and Traumatology, Faculty of Medicine, Universidade de São Paulo, São Paulo 05403-010, Brazil
José Carlos Bongiovanni
Department of Orthopedics and Traumatology, Universidade de Mogi das Cruzes, Mogi das Cruzes 08780-911, Brazil
Thomas Stravinskas Durigon
Department of Orthopedics and Traumatology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-900, Brazil
Mauro José Salles
Infectious Diseases Discipline, Department of Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-900, Brazil
Fernando Baldy dos Reis
Department of Orthopedics and Traumatology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-900, Brazil
Background: The aim of this study is to evaluate the outcome of patients with cavitary chronic osteomyelitis undergoing adjuvant treatment with bioactive glass (BAG) S53P4 and identify the independent risk factors (RFs) for recurrence in 6- and 12-month patient follow-up. Methods: A retrospective, multicentre observational study conducted in tertiary specialised hospitals among patients undergoing the surgical treatment of chronic cavitary osteomyelitis using BAG-S53P4 in a granule and/or putty formulation to assess the clinical outcome and RFs for failure in 6- and 12-month patient follow-up. Results: Of the 92 and 78 patients with 6-month and 12-month follow-ups, infection was eradicated in 85.9% and 87.2%, respectively. In the 6-month follow-up, BAG-S53P4 in the granule formulation presented a greater risk of recurrence compared to the bioactive glass putty formulation or combined granules and putty (prevalence ratio (PR) = 3.04; confidence interval 95% [CI95%]: 1.13–10.52) and neoplasia (PR = 5.26; CI95%: 1.17–15.52). In the 12-month follow-up cohort of 78 patients, smoking (PR = 4.0; 95% CI: 1.03–15.52) and nonfermenting GNB infection (PR = 3.87; CI95%: 1.09–13.73) presented a greater risk of recurrence. Conclusions: BAG-S53P4 is a viable option for bone-void filling and the treatment of chronic cavitary osteomyelitis. Formulations of BAG with putty or in combination with granules showed better results.
