Clinical, Microbiological and Therapeutic Profile of Patients With Osteomyelitis Followed at a Multidisciplinary Outpatient Clinic Implemented in a Trauma Reference Hospital in Northeast Brazil

Osteomyelitis requires prolonged hospitalizations and extended use of antimicrobials. In order to promote safe dehospitalization and rationalize resources, a multidisciplinary outpatient clinic including an infectious disease specialist and a pharmacist was established. This study evaluates the initial results of outpatient follow-up, focusing on treatment adherence and clinical evolution. Prospective cohort of patients aged over 18 years with a diagnosis of osteomyelitis, hospitalized in a trauma reference hospital in Ceará, from May to July 2025. The study was approved by the institution’s Research Ethics Committee (No. 6.624.375). Seventeen patients with chronic osteomyelitis related to fracture fixation were identified, all due to motor vehicle accidents. Median age was 37 years and 94.1% were male. Fractures were located in the tibia (82.4%) and ankle (17.6%). On admission, 88.2% had some type of fixation hardware; no patient had an Ilizarov frame and 17.6% (3/17) had an intramedullary nail. Cultures were positive in 76.5% (13/17). The most frequently isolated microorganisms were Staphylococcus aureus (84.6%), Pseudomonas aeruginosa (15.4%) and Aeromonas hydrophila (15.4%). S. aureus isolates showed 100% susceptibility to sulfamethoxazole-trimethoprim, 36.4% to rifampicin, 36.4% to levofloxacin and 27.3% to clindamycin. Twelve patients (70.6%) received one week of intravenous antimicrobials and were discharged for outpatient follow-up with oral therapy; five (29.4%) continued on intravenous regimens only due to the absence of oral alternatives. Among the 12 patients treated as outpatients, 58.3% (7/12) completed 6 weeks of antibiotic therapy and 41.7% (5/12) continued for 12 weeks, due to nonunion fractures with fixation hardware (60%) or infection of an intramedullary nail (40%). All received sulfamethoxazole-trimethoprim; it was combined with ciprofloxacin in four cases and with rifampicin in one. No antibiotic changes or adverse events were observed. All patients reported good adherence, with clinical improvement and reduction of inflammatory markers. Despite the small number of patients in the study period, the creation of the first multidisciplinary osteomyelitis outpatient clinic in Ceará proved feasible and safe, with high adherence, absence of adverse events and good clinical response. The findings suggest that oral antibiotic therapy can be an effective strategy to expand safe dehospitalization in osteoarticular infections.