An evaluation of pressure injury associated pelvic osteomyelitis in patients with spinal cord injuries in a Veterans Affairs population.

CONTEXT: Pressure injury (PI)-related pelvic osteomyelitis in patients with spinal cord injuries (SCI) is associated with significant morbidity and mortality. Limited data are available to dictate optimal management. The presented work describes the management of patients with SCI and PI-related osteomyelitis managed by a multidisciplinary Veterans Affairs team. METHODS: A descriptive retrospective chart review of patients ≥ 18 years of age with a culture-positive clinical diagnosis of PI-associated pelvic osteomyelitis between January 2018 and October 2023 was conducted. Baseline demographics, SCI injury characteristics, treatment regimens, and surgical interventions were collected. Treatment failure was defined as relapse, need for chronic suppressive therapy, or death due to osteomyelitis. Differences in patient characteristics and treatments received between those that experienced treatment success and failure were compared using Fisher's exact test. RESULTS: A total of 31 patients were identified, with a median age of 66 years; the majority were male (97%). Cultures were predominantly polymicrobial (81%) and grew multidrug-resistant organisms (62%). Nineteen patients (61%) had a surgical intervention performed, which was primarily debridement. Eight patients (26%) met the criteria for treatment failure. Patients in the treatment success group were more likely to receive a non-beta-lactam-containing regimen (57% vs. 0%, p = 0.0096). The median treatment durations were 63 vs 57 days in the treatment success and failure groups respectively. CONCLUSION: In this review of PI-associated osteomyelitis, most patients had polymicrobial infections caused by multidrug resistant organisms. Choice of a non-beta-lactam regimen was associated with treatment success. Larger studies are needed to adequately describe optimal management of these patients.