What is Hyperbaric Treatment of Chronic Refractory Osteomyelitis?
Osteomyelitis is an infection in the bone or bone marrow, usually caused by bacteria. Treating this condition can be challenging because bones don’t have many blood vessels, and many infection-fighting medicines struggle to reach the bone. A stubborn form of this disease, known as refractory osteomyelitis, continues to exist or comes back even after proper treatment.
People with this infection in their spine, skull, or chest bone are at a high risk for serious health complications, and the infection can potentially be life-threatening. Common treatments for chronic and stubborn osteomyelitis include surgery to clean the infected area and antibiotics specifically chosen based on the type of bacteria causing the infection.
Hyperbaric oxygen treatments, where patients breathe pure oxygen in a pressurized room or tube, are another recommended treatment in America for long-standing and stubborn osteomyelitis. Additionally, this therapy is strongly recommended for people with severe diabetic foot ulcers accompanied by osteomyelitis.
Recent studies suggest that up to one in five patients seeking treatment for severe diabetic foot ulcers at Wound Care Centers already have osteomyelitis. An ongoing infection in the bone can be one reason why a wound isn’t healing. Therefore, if a patient has a wound that has been around for a while and is not healing, a doctor may look for osteomyelitis.
What Causes Hyperbaric Treatment of Chronic Refractory Osteomyelitis?
Staphylococcus and Streptococcus are types of bacteria that are often found in infants and children when there is an infection spread through the bloodstream. In adults, a type of bacteria called S aureus is usually found. These infections can spread through the bloodstream or by bacteria directly entering the bone. Using drugs through a needle has been connected to this kind of infection in the long bones or the vertebrae, also known as the bones in the spine.
Chronic refractory osteomyelitis refers to a bone infection that doesn’t get better with standard treatments like antibiotics and surgery. To be considered “chronic” (long-standing) and “refractory” (resistant to treatment), the infection usually has to have had at least 6 weeks of appropriate antibiotic treatment and surgery, if need be, without getting better or healing.
A common issue faced in wound clinics is when a patient, due to not following the doctor’s orders or lack of knowledge on the part of the doctor, gets treated with antibiotics for a shorter time than needed or doesn’t have follow-up tests to check the reaction to the treatment. These patients often return months later with a wound that has reopened or a draining fluid from a passage in the body, as the body attempts to get rid of the stubborn infection in the bone.
Risk Factors and Frequency for Hyperbaric Treatment of Chronic Refractory Osteomyelitis
Osteomyelitis, a type of bone infection, accounts for about 50,000 hospital admissions in the United States every year. This means nearly 1 in every 675 hospital stays is due to this condition. People who have diabetes, use intravenous drugs, or have weakened immune systems are more likely to get osteomyelitis. About half of all cases of osteomyelitis happen after an injury. Other common causes are nerve damage, which is often seen in diabetics, and infections that spread through the blood, which usually happens in children.
Standard treatment for osteomyelitis usually involves surgery and antibiotics. The success rate for this treatment can vary widely, with anywhere from 35% to 100% of cases fully healing. Generally, it’s estimated that between 70% and 80% of patients will be cured with this treatment. However, 20% to 30% of patients might have the infection come back later. For those situations where the standard treatments don’t work, the infection gets worse or comes back, or it infects a particularly risky area of the body, doctors may consider using hyperbaric oxygen treatments.
Signs and Symptoms of Hyperbaric Treatment of Chronic Refractory Osteomyelitis
Chronic wounds that don’t heal are often caused by an underlying condition called osteomyelitis. This is an infection in the bone that can prevent wounds from healing properly. Symptoms that might suggest osteomyelitis include wounds that don’t heal, keep reopening, have drainage, or are located where medical devices have been implanted in the body. It’s crucial to be aware of this, particularly for people with joint replacements, because a bone infection could have severe consequences.
Testing for Hyperbaric Treatment of Chronic Refractory Osteomyelitis
If a doctor suspects you might have osteomyelitis, a type of bone infection, they will likely order some lab tests for you. Two of these tests are called erythrocyte sedimentation rate and C-reactive protein. If the results of these tests show high levels, it strongly suggests you could have osteomyelitis.
In addition to these blood tests, your doctor might use a type of medical imaging called an MRI. MRI stands for Magnetic Resonance Imaging, and it’s considered the most reliable way to visualize osteomyelitis inside your body. Regular X-rays often don’t show osteomyelitis, which is why an MRI is usually necessary.
It’s also common to perform a bone biopsy, which involves taking a small sample of bone to examine. This helps your doctors to know exactly which antibiotics will be most effective for treating your infection.
To make sure you receive the best possible care, you will likely have a team of specialists working together. This team might include a surgeon, an infectious disease expert, and a specialist in wound and hyperbaric medicine. Together, they can work on the most effective plan to manage your condition.
Treatment Options for Hyperbaric Treatment of Chronic Refractory Osteomyelitis
If osteomyelitis (a bone infection) does not improve after being treated with specific
antibiotics for 4 to 6 weeks, it becomes known as chronic refractory osteomyelitis (CRO). In these cases, patients may need an additional treatment called hyperbaric oxygen therapy, which a doctor will recommend.
Hyperbaric oxygen therapy helps improve the effectiveness of certain antibiotics, like cephalosporins and aminoglycosides, in fighting the bone infection and aids the body in creating new bone tissue. This therapy works by increasing the amount of oxygen in infected bone, as it has been found that infected bones have lower than normal oxygen levels.
Once the oxygen amount in the infected bone is restored to normal or above normal levels, the body’s white blood cells are better able to kill bacteria causing the infection. Additionally, the therapy improves the absorption of antibiotics into the infected bone, which may help resolve the bone infection faster.
What else can Hyperbaric Treatment of Chronic Refractory Osteomyelitis be?
When considering hyperbaric treatment for chronically resistant osteomyelitis (a severe, persistent bone infection), doctors need to rule out several other conditions that might produce similar symptoms. These include:
- Charcot joint (a condition affecting the joints)
- Cellulitis (a skin infection)
- Ewing sarcoma (a type of bone cancer)
- Giant cell tumour (a bone tumour)
- Gout and pseudogout (types of painful arthritis)
- Infectious arthritis (joint infection)
- Rheumatoid arthritis (a long-term autoimmune disorder)
- Septic arthritis (infection in the joints)
- Sickle cell anemia (a group of genetic disorders affecting the red blood cells)
What to expect with Hyperbaric Treatment of Chronic Refractory Osteomyelitis
If patients are diagnosed quickly and given the right antibiotics according to the infection present, along with appropriate surgical cleaning of the wound (if needed), and routine local care of the wound, their condition can improve significantly. In these cases, they can be treated until their wound is completely healed. However, patients with uncontrolled diabetes or other health issues may not recover as well.
Long-term treatment and continuous monitoring are imperative for the patient’s recovery. The importance of treatment from a team of healthcare professionals coming from various disciplines must be emphasized to the patient. This approach can greatly help in managing their condition.[3]
Possible Complications When Diagnosed with Hyperbaric Treatment of Chronic Refractory Osteomyelitis
The biggest problem occurs when doctors don’t immediately suspect and diagnose the issue. This delay can cause serious issues for the patient, such as severe wound complications. In cases involving the foot or lower limb, this could even result in the need for major amputation.
Common Risks:
- Delayed diagnosis
- Severe wound complications
- Possible major amputation when a foot or lower limb is involved
Preventing Hyperbaric Treatment of Chronic Refractory Osteomyelitis
People with diabetes need to take extra care of any wounds they get. It’s really important to call your healthcare professional, like a foot doctor or a podiatrist, at the earliest sign of any wound. Regular check-ups with your foot doctor and the doctor who helps with your diabetes control, the endocrinologist, are also crucial. Keeping your blood sugar levels well-managed can prevent infections and stop your white blood cells from losing their ability to fight against these infections. This is particularly important for those whose diabetes is not well-controlled.