Tyler H Haeffs1, Christopher A Scott1, Tiffany H Campbell2, Youbai Chen3, Meredith August4. 1. Predoctoral Student, Harvard School of Dental Medicine, Boston, MA. 2. Resident, Department of Dentistry, Massachusetts General Hospital, Boston, MA. 3. Master's Program in Clinical Investigation, Harvard Medical School, Boston, MA. 4. Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: maugust@partners.org.
Abstract
PURPOSE: To review cases of suppurative osteomyelitis of the jaws treated at the Massachusetts General Hospital (Boston, MA) over a 10-year period, evaluate specifics of disease presentation, and answer the clinical question: are there identifiable variables associated with treatment outcome? MATERIALS AND METHODS: A retrospective cohort study was completed using patients treated for suppurative osteomyelitis of the jaws at the Massachusetts General Hospital from April 2006 to October 2016. Inclusion criteria were a diagnosis of suppurative osteomyelitis of the jaw, age older than 18 years, and complete medical records. Patients with nonsuppurative disease, radiation history, or antiresorptive exposure were excluded. Candidate variables included demographic information, medical and dental history, presenting signs and symptoms, and radiologic and laboratory findings. The outcome variable was successful treatment, defined as resolution of symptoms and radiographic evidence of healing after initial treatment. Appropriate statistical analyses were performed with significance set a P value less than .05. RESULTS: Forty-two patients met the inclusion criteria. Mean age was 53 years (range, 20 to 80 yr) and 26 were women (62%). Common comorbidities included cardiovascular disease (52%), tobacco use (45%), and psychiatric disorders (45%). Pain (90%), swelling (86%), and neurosensory change (50%) were the most common findings. Common microbacterial isolates included Streptococcus milleri (74%) and coagulase-negative Staphylococcus species (43%), which showed marked antibiotic resistance. Surgical debridement was the most common intervention (93%). Successful treatment was found in 86%. Of 6 persistent cases, 4 resolved with a second debridement and continued antibiotics and 2 required resection. Increased white blood cell (WBC) count at presentation (P = .005) and associated psychiatric diagnoses (P = .037) were statistically associated with unsuccessful initial treatment. CONCLUSION: The results of this study indicate that antibiotic resistance is commonly encountered in this patient population, although it was not associated with unsuccessful outcome. Patients presenting with increased WBC count and concurrent psychiatric comorbidities required protracted treatment.
PURPOSE: To review cases of suppurative osteomyelitis of the jaws treated at the Massachusetts General Hospital (Boston, MA) over a 10-year period, evaluate specifics of disease presentation, and answer the clinical question: are there identifiable variables associated with treatment outcome? MATERIALS AND METHODS: A retrospective cohort study was completed using patients treated for suppurative osteomyelitis of the jaws at the Massachusetts General Hospital from April 2006 to October 2016. Inclusion criteria were a diagnosis of suppurative osteomyelitis of the jaw, age older than 18 years, and complete medical records. Patients with nonsuppurative disease, radiation history, or antiresorptive exposure were excluded. Candidate variables included demographic information, medical and dental history, presenting signs and symptoms, and radiologic and laboratory findings. The outcome variable was successful treatment, defined as resolution of symptoms and radiographic evidence of healing after initial treatment. Appropriate statistical analyses were performed with significance set a P value less than .05. RESULTS: Forty-two patients met the inclusion criteria. Mean age was 53 years (range, 20 to 80 yr) and 26 were women (62%). Common comorbidities included cardiovascular disease (52%), tobacco use (45%), and psychiatric disorders (45%). Pain (90%), swelling (86%), and neurosensory change (50%) were the most common findings. Common microbacterial isolates included Streptococcus milleri (74%) and coagulase-negative Staphylococcus species (43%), which showed marked antibiotic resistance. Surgical debridement was the most common intervention (93%). Successful treatment was found in 86%. Of 6 persistent cases, 4 resolved with a second debridement and continued antibiotics and 2 required resection. Increased white blood cell (WBC) count at presentation (P = .005) and associated psychiatric diagnoses (P = .037) were statistically associated with unsuccessful initial treatment. CONCLUSION: The results of this study indicate that antibiotic resistance is commonly encountered in this patient population, although it was not associated with unsuccessful outcome. Patients presenting with increased WBC count and concurrent psychiatric comorbidities required protracted treatment.
Authors: Julius Moratin; Christian Freudlsperger; Karl Metzger; Caroline Braß; Moritz Berger; Michael Engel; Jürgen Hoffmann; Oliver Ristow Journal: Clin Oral Investig Date: 2020-07-07 Impact factor: 3.573
Authors: Michał Michalik; Alfred Samet; Adrianna Podbielska-Kubera; Vincenzo Savini; Jacek Międzobrodzki; Maja Kosecka-Strojek Journal: Ann Clin Microbiol Antimicrob Date: 2020-06-04 Impact factor: 3.944