OSTEOMYELITIS ASSOCIATED WITH PRESSURE SORES

Background: Pressure sores maybe associated with underlying osteomyeli tis that is difficult to differentiate clinically from infection or co lonization of adjacent soft tissue. Cultures of bone specimens are fre quently contaminated with organisms residing in adjacent soft tissue. The three objectives of this cohort study were to (1) determine the ac curacy of clinical evaluation for osteomyelitis; (2) evaluate the pote ntial role of quantitative cultures of bone in differentiating osteomy elitis from soft-tissue infection or colonization; and (3) assess the impact of treating osteomyelitis on the outcome of pressure sores. Met hods: Thirty-six patients with pressure sores related to spinal cord i njury or cerebrovascular accident underwent clinical evaluation for os teomyelitis, followed by percutaneous needle biopsy of bone. Routine s emiquantitative and quantitative, aerobic and anaerobic cultures of bo ne specimens were performed. Pathologic examination of bone tissue was used as the standard criterion for diagnosing osteomyelitis. Results: Six (17%) of 36 patients were diagnosed by pathologic examination as having osteomyelitis. The sensitivity and specificity of clinical eval uation were 33% and 60%, respectively. When positive, quantitative bon e cultures yielded a similar number of bacterial isolates and a compar able range of bacterial concentration in patients with osteomyelitis v s those without osteomyelitis. Pressure sores healed in all six patien ts with osteomyelitis after appropriate therapy. Conclusions: Clinical evaluation for osteomyelitis is often, inaccurate. Pathologic examina tion of bone tissue is required for definitive diagnosis of osteomyeli tis. Quantitative bone cultures do not help differentiate osteomyeliti s from infection or colonization of adjacent soft tissue. It is possib le that treatment of osteomyelitis may improve the outcome of associat ed pressure sores.