Systematic review of the microbiology of osteomyelitis associated with war injuries in the Middle East and North Africa

ABSTRACT

Osteomyelitis is a serious complication associated with war-related limb injuries requiring complicated treatment regimens and management. Few reports have been published from the Middle-East and North-Africa regions about the microbial aetiology of osteomyelitis caused by war injuries. The aim of this review is to collect published data about the microbiology of osteomyelitis in war-related injuries in the region and to derive targeted treatment regimens to manage these serious and limb-threatening infections. A thorough literature search was done using six search engines for pertinent articles. Articles with a minimum of five cases of osteomyelitis from war wounds, citation of microbial aetiology and mention of the timing of cultures obtained in relation to injury were included. Nine studies that met the eligibility criteria were included, involving 1644 patients and a total of 2332 cultures. Gram-negative bacteria were isolated from 1184 cultures, and Gram-positive bacteria were identified from 1148 cultures. Antibiotic coverage should be tailored for Gram-negative organisms in the early stages and Gram-positives in the chronic phase, respectively, with broader coverage reserved for critically ill patients. There is a dire need for further and larger studies about osteomyelitis from war injuries for targeted treatment.

KEYWORDS:

• War
• conflict
• infection
• injury
• osteomyelitis
• drug resistance

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The study was unfunded and no sponsors were involved in it.

Notes on contributors

Fadi Ghieh

Fadi Ghieh, MD is a Plastic and Reconstructive Surgery chief resident at the American University of Beirut Medical Center. He is currently applying for pursuing a fellowship in Europe. Dr Ghieh has over 20 publications in the field of Plastic and Reconstructive Surgery.

Abdul Rahman Bizri

Abdul Rahman Bizri, MD is an Assistant Professor of Clinical Medicine at the Department of Internal Medicine, American University of Beirut Medical Center in infectious diseases. Dr Bizri played a major role in infection control programs at AUBMC, and he was heavily involved as the head of the vaccination campaign during the COVID 19 pandemic. Dr Bizri is a current deputy in the Lebanese parliament playing a major role in improving healthcare systems and protocols within the country.

Paul Beaineh

Paul Beaineh, MD is a Plastic and Reconstructive Surgery resident at the American University of Beirut Medical Center. Dr Beaineh is interested in all aspects of cosmetic and reconstructive surgery working on different research projects in the field.

Rawad Chalhoub

Rawad Chalhoub, MD is a Plastic and Reconstructive Surgery resident at the American University of Beirut Medical Center. Dr Chalhoub is interested in all aspects of cosmetic and reconstructive surgery working on different research projects in the field.

Ghassan Abu Sittah

Ghassan Abu SIttah, MBchB, FRCS is a Plastic and Reconstructive surgeon. In 2012 he became Head of the Division of Plastic and Reconstructive Surgery at the AUBMC, Clinical Lead of its Pediatric War injuries program and War Injuries Multidisciplinary Clinic. In 2015 co-founded and became director of the Conflict Medicine Program at Global Health Institute at the American University of Beirut. He returned to the UK in 2020 and continues in Plastic and Reconstructive Surgery in the private sector. He is an Honorary Senior Clinical Lecturer at the Center for Blast Injury Studies at Imperial College University of London and Visiting Senior Lecturer at the Conflict & Health Research Group at King's College London University.