Treatment of combat-related traumatic chronic osteomyelitis with tigecycline: a case series

Objective: To evaluate the efficacy of tigecycline treatment in Combat-Related Traumatic Chronic Osteomyelitis (CRTCO). Methods: A retrospective study evaluated tigecycline in the treatment of CRTCO. Cases were reviewed for patients who were treated for the period 2011 - June 2012. During the tigecycline treatment period, orthopedic surgeon taking care of patients started tigecycline treatment upon their discretion, not knowing about the pending study Results: Ten cases were included (one female), mean age 45.5 years. Most common involved bones with CRTCO were femur followed by tibia. Microbiological diagnoses were obtained mostly from bone biopsies and bone swabs. Microorganisms isolated were Acinetobacter spp. (6), Klebsiella pneumoniae (6), Escherichia coli (5), Pseudomonas aeruginosa (4), Enterococcus spp. (3), Staphylococcus aureus (1). Tigecycline mean duration of treatment was 35.7 days (range 21 - 91). Patients were treated with other antimicrobials earlier to tigecycline for a mean duration of 467.37 days (range 2 - 1825). Reasons for switching to tigecycline were: Clinical failure in all patients, in addition to side effects and microbiological failure of previous regimen. Paired difference of the ESR for eight available patients’ pair was not significant (p = 0.055), the same was for CRP (p = 0.9). Clinically improved patients were seven cases (70%). Conclusion: CRTCO is a polymicrobial infection mostly caused by gram-negative bacilli. The outcome of treating these infections with tigecycline is promising