Aditya H. Gaur, M.D. 1, Tiebin Liu, M.S.P.H. 2, Katherine M. Knapp, M.D. 1, Najat C. Daw, M.D. 3 4, Bhaskar N. Rao, M.D. 5 6, Michael D. Neel, M.D. 5 6, Carlos Rodriguez-Galindo, M.D. 3 4, Diane Brand, R.N. 1, Elisabeth E. Adderson, M.D. 1 4 7 *
Keywords bone tumor therapy infection bacteremia prosthetic device infection orthopedic device infection
Abstract
BACKGROUND The epidemiology, risk factors, and efficacy of therapy for infections complicating limb-sparing surgery (LSS) are not understood completely.
METHODS The authors conducted a retrospective review of children and adolescents with bone malignancies who underwent LSS.
RESULTS One hundred three patients underwent 104 LSS procedures. Patients experienced a median of 4 infections (range, 0-13 infections), including focal bacterial infections in 67% of patients and bacteremia in 21% of patients. Infections at the LSS site occurred in 26% of patients, and 21% of patients developed orthopedic device infections (ODIs). Compared with patients without ODIs, patients who developed ODIs were more likely to be African American and to have wound infections, and they were less likely to have tumors of the femur than the tibia. In a multivariate analysis, only African-American race and local infection at the LSS site retained a significant association with ODIs. Among survivors, patients who developed ODIs were more likely to undergo amputation (odds ratio [OR], 24.0; 95% confidence interval [95%CI], 5.1-114.0; P < 0.001) and were less likely to have good functional outcomes (OR, 0.02; 95%CI, 0.002-0.15; P < 0.001) compared with patients who did not have an ODI. Overall, only 1 of 22 patients with an ODI was treated successfully without removal of the orthopedic device or amputation.
CONCLUSIONS Current treatment for bone malignancies is complicated by an unexpectedly high incidence of infection. ODI was the most common reason for amputation and poor functional outcomes. The identification of risk factors for ODI may allow modifications of therapy that reduce the incidence and severity of infection, but prevention of all ODIs will require novel strategies. Cancer 2005. © 2005 American Cancer Society.
1Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 2Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee 3Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 4Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee 5Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee 6Department of Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee 7Department of Molecular Sciences, University of Tennessee Health Sciences Center, Memphis, Tennessee
email: Elisabeth E. Adderson (elisabeth.adderson@stjude.org)
*Correspondence to Elisabeth E. Adderson, Department of Infectious Diseases, St. Jude Children's Research Hospital, Room. E8074, Mail Stop 600, 332 N. Lauderdale St., Memphis TN 38105
Fax: (901) 495-3099
Funded by: National Institutes of Health; Grant Number: CA21765 American Lebanese Syrian Associated Charities
