1429. Diagnosis and Management of Osteomyelitis Associated with Stage IV Pressure Ulcers: Report of a Query to the Emerging Infections Network of the Infectious Diseases Society of America

Background Despite the high prevalence and morbidity of stage IV pressure ulcers, there are few clinical studies to guide diagnosis and treatment of osteomyelitis in such patients. Methods The Emerging Infections Network conducted an electronic survey of adult ID physicians in 2018 to determine their approach to managing patients with stage IV pressure ulcers (exposed bone, tendon, or muscle) and osteomyelitis. Results The overall response rate was 42% (558/1,332). Of the respondents, 94/558 (17%) had not seen such patients in the last year, so opted out. Of the remaining 464 respondents, 276 (60%) usually felt confident in diagnosing osteomyelitis by physical examination, and laboratory or imaging test results; the strongest indicator of osteomyelitis was thought to be palpable or visible bone at the ulcer base (Figure 1). Approaches to diagnosing osteomyelitis in patients with visible and palpable bone varied: 41% would assume osteomyelitis was present, 27% would try local wound care and pressure-offloading before doing tests, 22% would do diagnostic tests immediately, and 10% would follow another strategy. The preferred tests for osteomyelitis were bone biopsy (for culture or histopathology) and MRI (Figure 2). Regarding treatment, respondents differed widely regarding favored route(s) of antimicrobial therapy (all IV, partly IV and partly oral, or all oral), regardless of presumed pathogen (Figure 3). Respondents also differed widely regarding preferred duration of antimicrobial therapy, but generally would treat longer in the absence of full surgical debridement (P < 0.001 overall) (Figure 4). Overall, 62% of respondents believed that osteomyelitis under stage IV pressure ulcers usually or almost always is treated excessively. Most respondents (59%) had multiple suggestions for future research, primarily regarding the duration and utility of antimicrobial therapy in this context. Conclusion ID physicians (i) report significant practice variability in their approach to diagnosing and treating osteomyelitis underlying stage IV pressure ulcers, (ii) are concerned about excessive antibiotic use in such patients, and (iii) perceive a critical need for additional research in this area. Disclosures All authors: No reported disclosures.