Outcomes of single stage treatment of chronic bone infection in adults with antibiotic impregnated calcium sulphate beads; A single centre retrospective study with a mean follow-up of 5.5 years.

Abstract

Chronic bone infection is a challenging condition to treat, often requiring multiple surgeries and prolonged antibiotic therapy, which although effective, can increase patient morbidity and are resource intensive. This study was designed to evaluate midterm results of a single-stage management approach for chronic bone infection, incorporating debridement, local antibiotic delivery via calcium sulphate antibiotic loaded carrier (CALC), and soft-tissue coverage to effectively manage infection and improve patient outcomes while minimizing morbidity associated with multi-stage procedures. In this retrospective observational cohort study, patients who underwent single-stage surgery with a minimum of two-year follow-up were included. Data on demographics and clinical outcomes were collected. Key objectives included assessing disease recurrence, treatment impact, and postoperative complications. Ninety-three patients, of which 60 were male, were included, with a mean age of 51 years. The median follow-up period was 57.5 months. The mean postoperative stay was 13 days. Thirty-nine patients were smokers, 11 were diabetics, and 10 had peripheral vascular disease. The leading cause of chronic bone infection was fracture related infection following trauma (n = 68), predominantly affecting the tibia (n = 33). Significant microbiological growth occurred in 77 patients with Staphylococcus aureus being the predominant pathogen (n = 42). Cierny-Mader classification revealed 31 patients with localized lesions in Class B hosts and 25 in Class A hosts. Only 24 patients required surgical stabilization at index procedure. Most patients (n = 70) underwent excision with primary closure, while 22 needed a soft tissue flap. Postoperative complications included wound leakage in 21 cases, with 13 recurrent infections, 10 of which needed further surgery. An infection control rate was initially achieved at 86%, and 89.2% at a 5.5-year follow-up. Our study constitutes a large patient cohort with one of the longest available follow-up periods. Single-stage management of chronic bone infection with intralesional debridement using antibiotic impregnated CaSO₄ pellets is safe and an effective method with low recurrence rates. Our results suggest that pre-operative sampling is not essential for successful outcomes. A multidisciplinary approach following the essential basic principles of the management of CBI is essential.