The potential value of the sedimentation rate in monitoring treatment outcome in puncture-wound-related Pseudomonas osteomyelitis

Recently, a recommendation was made to treat Pseudomonas osteomyelitis in children with only ten to 14 days of postsurgical antibiotics. However, there were no clinical or laboratory measurements to monitor the response. Fourteen new cases of puncture-wound-related Pseudomonas osteomyelitis of the foot in children were investigated to examine the response of erythrocyte sedimentation rate (ESR) to treatment. The ESR was increased in 12/12 patients with a mean peak of 41 mm/hr and a mean duration of 30 days. After appropriate treatment was begun, the ESR decreased at a mean rate of 1.1 mm/day. In four of five patients with a poor treatment response, the ESR remained elevated until antibiotics were changed (in 3) or surgery performed (in 1). One patient with an abnormal ESR at completion of three weeks of postoperative antibiotics had a relapse after one year. These data suggest a need for careful assessment of treatment response, such as declining ESR, before antibiotics are discontinued at an arbitrary postoperative time period.