Two presentations of pubic osteomyelitis are described with differences in pathophysiology and treatment.

The blood-borne presentation of pubic osteomyelitis is usually monomicrobial, due to methicillin-resistant S. aureus, and mostly observed in young patients without comorbidities.

The postoperative presentation is mostly polymicrobial and occurs in elderly patients with comorbidities such as pelvic malignant tumor.

To describe the epidemiology of pubic osteomyelitis (PO) and to look for factors associated with treatment failure.

Retrospective study describing PO according to outcome: success or failure of initial management. Factors associated with failure determined by univariate Cox analysis. Kaplan-Meier curve compared between groups by log-rank test.

Twenty-five patients were included over a 13-year period; 24% of PO had blood-borne infection. Failure (44%) was always observed in chronic postoperative presentations (76%). Fistula (32%) was only observed in postoperative presentations and was significantly associated with failure (HR 5.1; P = 0.011). Other risk factors were pelvic malignant tumor history, abscess, infection due to extended-spectrum beta-lactamase-producing Enterobacteriaceae, and polymicrobial infection.

PO is most often a chronic postoperative polymicrobial infection in patients with comorbidities at high risk of relapse. Studies in larger cohorts could assess the efficacy of more aggressive surgical strategies in patients at high risk of failure.

Bone and joint infections

Pubis

Antibiotic failure

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