Chronic Osteomyelitis, Biofilm, and Local Antibiosis
Postoperative and posttraumatic infections of bones, soft tissues, and joints still present a large problem and are among the most serious complications despite huge advances in the field of medicine.
Osteomyelitis is a heterogeneous disease regarding its pathophysiology, clinical presentation, as well as management.
Osteomyelitis basically means inflammation of bone and bone marrow components. This could be of bacterial origin, but may also result from tuberculosis or syphilis and, depending on the immune status of host, may even be of fungal or parasitic (echinococci, toxoplasma ) origin.
Osteomyelitis as a condition may develop as a result of contiguous spread of the infectious organism from adjacent soft tissues and joints, hematogenous seeding by the bloodstream (endogenous), or by direct inoculation and colonization into the bone. The bacteria reach the bones through skin lesions and soft-tissue necroses as a result of trauma or surgery (exogenous). The term osteomyelitis has achieved worldwide acceptance. From a pathologic-anatomical point of view, osteomyelitis can be differentiated into a focal form – referred to as a bone abscess – and one with diffuse spread. As the treatment of bone, soft-tissue, and joint infection has slowly been changing with an evolution and renaissance in understanding the process of managing the infection, the epidemiology of the condition appears to have evolved over time.
Despite the efforts to decrease the incidence of osteomyelitis, the increased survival rates in posttraumatic patients, especially those with extensive injury and bone exposure, have been accompanied by an increased incidence of posttraumatic osteomyelitis. Furthermore, improved life expectancy among elderly patients with diabetes mellitus has resulted in more cases of neuropathy, vascular insufficiency, and the associated local complications of soft-tissue loss, bone destruction, and osteomyelitis (Kremers et al., J Bone Joint Surg Am 97:837–845, 2015; Schnettler and Alt, eptic bone and joint surgery. New York: Thieme Publishing Group; 2010).
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