Chronic Refractory Osteomyelitis Treatment
Infections in bone are hard to treat because there are not a lot of blood vessels in the bone. Antibiotics have a hard time penetrating bone. Chronic refractory osteomyelitis (CROM) is a bone infection that has not responded to conventional therapy, such as antimicrobials and surgical debridement, after a 6-week course of therapy.
These chronic bone infections can occur in pediatric patients as well as adult patients, although they are often associated with other local or systemic problems. Patients who are immunosuppressed or have other co-morbidities such as diabetes are more likely to develop CROM.
In some instances, where the bone infection has very high morbidity and mortality such as spine, skull, or sternum, osteomyelitis, which is not responding to treatment earlier than six weeks may benefit from adjunctive hyperbaric oxygen therapy. The most common presentation for CROM is in long bones after trauma, and in diabetic foot ulcers (DFU). In the DFU, about 20% of patients that are referred to a wound center will have osteomyelitis. If they do not respond to a course of conventional care, then patients should be referred for adjunctive hyperbaric oxygen therapy as part of a multi-disciplinary approach.