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Table 1 Comparison of patients with favorable and unfavorable outcome and determinants of treatment failure

From: Pressure ulcer-related pelvic osteomyelitis: evaluation of a two-stage surgical strategy (debridement, negative pressure therapy and flap coverage) with prolonged antimicrobial therapy

  Total population Superinfection Outcome
Superinfection p-value* OR (95%CI) p-value Treatment failure p-value# OR (95%CI) p-value
Demographics
 Male gender 46 (71.9%) 26 (66.7%) 0.242 0.400 (0.113–1.415) 0.155 12 (80.0%) 0.525 1.765 (0.434–7.181) 0.428
 Age, years 47.4 (35.6–62.6) 46.3 (34.0–62.9) 0.815 0.987 (0.713–1.365) a 0.935 50.3 (40.4–65.5) 0.521 1 .071 (0.737–1.555) a 0.720
Comorbidities
 BMI, kg/m2 23.6 (20.6–26.9) 24.1 (20.6–27.0) 0.784 1.033 (0.926–1.152) 0.560 22.9 (21.7–26.7) 0.869 0.996 (0.881–1.125) 0.948
 Albumin, g/L 28.0 (24.3–32.1) 29.5 (26.2–32.0) 0.037 1.106 (0.998–1.226) 0.055 26.5 (23.7–30.0) 0.354 0.959 (0.869–1.059) 0.412
 Prealbumin, g/L 0.2 (0.1–0.2) 0.2 (0.1–0.2) 0.285 142 (0.023–895,167) 0.267 0.2 (0.1–0.3) 0.716 0.964 (0.000–6272) 0.993
 Diabetes mellitus 9 (14.0%) 5 (12.8%) 1.000 1.029 (0.223–4.760) 0.970 2 (13.3%) 1.000 0.923 (0.170–5.003) 0.926
 Chronic renal failure 2 (3.1%) 1 (2.6%) 1.000 0.605 (0.036–10.152) 0.727 1 (6.7%) 0.417 3.429 (0.201–58.391) 0.394
 Chronic hepatic disease 4 (6.3%) 2 (5.1%) 0.632 0.595 (0.078–4.526) 0.616 3 (20.0%) 0.037 12.000 (1.145–125.816) 0.038
 Congestive heart failure 4 (6.3%) 3 (7.7%) 1.000 1.917 (0.188–19.559) 0.583 1 (6.7%) 1.000 1.095 (0.105–11.380) 0.939
 Peripheral artery disease 1 (1.6%) 1 (2.6%) 1.000 NC NC 0 (0.0%) 1.000 NC  
 Cerebral artery disease 2 (3.1%) 2 (5.1%) 0.521 NC NC 0 (0.0%) 1.000 NC  
 Immunodepression 4 (6.3%) 2 (5.1%) 0.632 0.595 (0.078–4.526) 0.616 1 (6.7%) 1.000 1.095 (0.105–11.380) 0.939
 Solid tumor or hemopathy 4 (6.3%) 3 (7.7%) 1.000 1.917 (0.188–19.559) 0.583 1 (6.7%) 1.000 1.095 (0.105–11.380) 0.939
 Gastroduodenal ulcer 4 (6.3%) 2 (5.1%) 1.000 1.243 (0.107–14.497) 0.862 1 (6.7%) 1.000 1.095 (0.105–11.380) 0.939
 Active smoking 25 (39.1%) 14 (35.9%) 0.596 0.662 (0.235–1.864) 0.435 6 (40.0%) 1.000 1.053 (0.323–3.433) 0.932
 ASA score 2.0 (2.0–3.0) 3.0 (2.0–3.0) 0.027 2.774 (1.103–6.974) 0.030 2.0 (2.0–3.0) 0.866 0.877 (0.340–2.261) 0.785
 Modified CCI 3.0 (2.0–5.0) 3.0 (2.0–5.0) 0.448 1.041 (0.857–1.264) 0.687 2.0 (2.0–4.0) 0.299 1.134 (0.927–1.385) 0.221
Causal disability
 Evolution delay, years 15.4 (7.5–26.2) 14.9 (5.8–31.4) 0.954 1.009 (0.969–1.051) 0.671 16.5 (9.1–26.2) 0.978 0.997 (0.953–1.043) 0.901
Context
 Hemiplegic 2 (3.1%) 1 (2.6%) 1.000 0.605 (0.036–10.152) 0.727 1 (6.7%) 0.417 3.429 (0.201–58.391) 0.394
 Paraplégic 41 (64.1%) 25 (64.1%) 1.000 0.893 (0.306–2.607) 0.836 8 (53.3%) 0.366 0.554 (0.171–1.798) 0.326
 Quadriplegic 12 (18.8%) 8 (20.5%) 0.509 1.806 (0.429–7.608) 0.420 3 (20.0%) 1.000 1.111 (0.259–4.717) 0.887
 Geriatrics 3 (4.7%) 2 (5.1%) 1.000 1.243 (0.107–14.497) 0.862 1 (6.7%) 0.558 1.679 (0.141–19.915) 0.682
 ICU 1 (1.6%) 1 (2.6%) 1.000 NC NC 0 (0.0%) 1.000 NC  
History of previous pressure ulcer
 At the same site 24 (37.5%) 17 (43.6%) 0.295 1.877 (0.635–5.549) 0.255 10 (66.7%) 0.013 5.000 (1.448–17.271) 0.011
 Previous surgery at the same site 22 (34.4%) 14 (35.9%) 1.000 1.120 (0.384–3.270) 0.836 9 (60.0%) 0.028 4.154 (1.236–13.960) 0.021
 Previous flap at the same site 9 (14.1%) 6 (15,4%) 1.000 1.273 (0.287–5.647) 0.751 4 (26.7%) 0.196 3.200 (0.735–13.938) 0.121
Actual pressure ulcer
 Sacrum 20 (31.3%) 13 (33.3%) 0.787 1.214 (0.403–3.661) 0.730 5 (33.3%) 1.000 1.133 (0.330–3.891) 0.842
 Ischium 43 (67.2%) 27 (69.2%) 0.585 1.350 (0.463–3.937) 0.583 10 (66.7%) 1.000 0.970 (0.284–3.312) 0.961
Surgical debridement
 Delay since ulcer onset, weeks 37.9 (14.0–109.6) 36.4 (16.2–131.1) 0.630 1.003 (0.997–1.009) 0.350 41.7 (10.6–132.6) 0.868 1.000 (0.996–1.003) 0.858
 CRP level at debridement, mg/L 42.2 (20.6–101.8) 43.0 (20.8–125.0) 0.948    52.5 (17.8–141.1) 0.792 1.001 (0.994–1.009) 0.708
Diverting colostomy 18 (28.1%) 14 (35.9%) 0.152 2.800 (0.796–9.843) 0.108 6 (40.0%) 0.326 2.056 (0.606–6.970) 0.247
Flap closure
 Delay since the last debridement, weeks 6.6 (4.9–9.6) 6.1 (4.8–9.9) 0.938 1.040 (0.946–1.144) 0.419 5.6 (5.1–8.0) 0.657 0.952 (0.843–1.076) 0.430
 CRP level at time of flap closure, mg/L 25 (14.7–43.6) 25.5 (14.4–46.0) 0.356 1.008 (0.985–1.031) 0.517 22.9 (15.5–28.1) 0.474 0.879 (0.947–1.012) 0.210
Broad spectrum antimicrobial use before flap closure
 3rdGC 14 (21.9%) 9 (23.1%) 1.000 1.140 (0.332–3.920) 0.835 5 (33.3%) 0.286 2.222 (0.609–8.108) 0.227
 Piperacillin-tazobactam 40 (62.5%) 21 (53.8%) 0.115 0.389 (0.127–1.190) 0.098 9 (60.0%) 1.000 0.871 (0.266–2.849) 0.819
 Carbapenem 16 (25.0%) 10 (25.6%) 1.000 1.034 (0.321–3.335) 0.955 6 (40.0%) 0.173 2.600 (0.749–9.029) 0.132
 Fluoroquinolone 18 (28.1%) 8 (20.5%) 0.157 0.430 (0.138–1.337) 0.145 5 (33.3%) 0.744 1.385 (0.398–4.818) 0.609
 Vancomycin 44 (68.8%) 27 (69.2%) 1.000 0.926 (0.305–2.818) 0.893 10 (66.7%) 1.000 0.882 (0.257–3.029) 0.842
Antimicrobial therapy
Intravenous antimicrobial therapy
 Total duration, weeks 15.7 (10.7–22.0) 19.4 (13.1–24.8) 0.021 NA NA 16.9 (8.1–26.4) 0.687 NA NA
 Duration from flap closure, weeks 7.9 (5.0–12.9) 10.1 (6.9–13.5) 0.008 NA NA 11.2 (4.4–14.7) 0.386 NA NA
 Relay to oral antimicrobial therapy 24 (38.7%) 11 (29.7%) 0.067 NA NA 7 (50.0%) 0.363 NA NA
 Total duration of antimicrobial therapy from flap closure, weeks 11.1 (7.5–15.1) 12.0 (8.0–15.1) 0.893 NA NA 13.4 (11.1–23.4) 0.011 NA NA
 Total duration of antimicrobial therapy, weeks 19.8 (13.8–27.4) 21.0 (13.9–25.2) 0.789 NA NA 28.9 (17.0–32.1) 0.109 NA NA
Outcome
 Treatment failure 15 (23.4%) 8 (20.5%) 0.545 0.627 (0.194–2.028) 0.435 15 (100.0%) NA NA NA
 Delay since flap closure, weeks 12.4 (7.3–28.3%) 15.9 (11.1–27.3) 0.563 NA NA 12.4 (7.3–28.3) NA NA NA
 Requirement of additional surgical procedure 14 (93.3%) 7 (87.5%) 1.000 NC NC 14 (93.3%) NA NA NA
 Relapse after treatment discontinuation 13 (20.3%) 7 (17.9%) 0.535 0.656 (0.191–2.254) 0.503 13 (86.7%) NA NA NA
 Death 4 (6.3%) 3 (7.7%) 1.000 1.917 (0.188–19.559) 0.583 2 (13.3%) 0.232 NC NC
 Infection-related death 2 (50.0%) 1 (33.3%) 1.000 NC NC 2 (100.0%) NC NC NC
  1. 3 rd GC, Third generation cephalosporin; 95%CI, 95% confidence interval; ASA, American society of anesthesiologists; BMI, Body mass index; CCI, Charlson comorbidity index; CoNS, Coagulase negative staphylococci; CRP, C-reactive protein; ESBL, Extended spectrum betalactamase: ICU, Intensive care unit; MRCoNS, Methicillin-resistant coagulase negative staphylococci; MRSA, Methicillin-resistant Staphylococcus aureus; NA, Not applicable; NC, Not calculable; OR, Odd ratio
  2. * In comparison to patients with no superinfection (Fisher exact test or Mann Whitney U-test, as appropriate)
  3. # In comparison to patients with no treatment failure (Fisher exact test or Mann Whitney U-test, as appropriate)
  4. a Calculated for 10 additional years
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