Managing Recurrent Osteomyelitis in the Context of Antimicrobial Resistance in Sub-Saharan Africa: A Narrative Review
Abstract
Evidence on recurrent chronic osteomyelitis, antimicrobial resistance and practical treatment strategies in Sub-Saharan Africa.
Chronic osteomyelitis remains a challenging surgical infection, with recurrence particularly problematic in resource-constrained settings across Sub-Saharan Africa. Antimicrobial resistance further complicates treatment and increases the need for practical, scalable and context-appropriate management strategies.
A narrative review was conducted using English-language publications from 2000 to 2025. Sources included PubMed, African Journals Online (AJOL), Google Scholar and World Health Organization resources. Search terms included chronic osteomyelitis, recurrent osteomyelitis, antimicrobial resistance and Sub-Saharan Africa. Grey literature and WHO reports were also reviewed.
Reported recurrence rates for chronic osteomyelitis in Sub-Saharan Africa ranged from approximately 2.8% to 16.7%. Adolescents and young adults were commonly affected. Staphylococcus aureus, including methicillin-resistant strains, and extended-spectrum beta-lactamase-producing Gram-negative bacteria were important antimicrobial resistance concerns. Low-cost local antibiotic delivery systems and biodegradable carriers showed promise, while simulation-based training and context-specific antimicrobial stewardship remained underused.
Practical strategies including low-cost local antibiotic delivery, simulation-based infection prevention training and tailored antimicrobial stewardship should be prioritized to reduce recurrence and strengthen outcomes for chronic osteomyelitis in resource-constrained settings.
Records identified from databases and grey literature.
Duplicate records removed before title and abstract screening.
Titles and abstracts screened for relevance.
Full-text publications assessed for eligibility.
Publications included in the final narrative synthesis.
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Narrative Review
The review synthesised evidence relating to recurrent chronic osteomyelitis in the context of antimicrobial resistance in Sub-Saharan Africa, with emphasis on recurrence, pathogen profiles, treatment challenges, low-cost innovations and training strategies.
Literature & Grey Literature
Sources included PubMed, African Journals Online, Google Scholar and World Health Organization resources, together with relevant grey literature. Publications from 2000 to 2025 were considered.
SSA Osteomyelitis Evidence
Eligible publications addressed chronic or recurrent osteomyelitis, recurrence rates, antimicrobial resistance patterns, treatment strategies, low-resource innovations or simulation-based training relevant to Sub-Saharan African settings.
Multiple Critical-Appraisal Tools
Two reviewers independently assessed methodological quality. The review used the Cochrane Risk of Bias tool for randomized trials, Newcastle–Ottawa Scale for cohort and case-control studies, Joanna Briggs Institute checklists for cross-sectional and case-series studies, and the CASP qualitative checklist for qualitative or implementation studies.
Adapted GRADE Approach
Included evidence was assigned a certainty rating of High, Moderate, Low or Very Low using an approach adapted from GRADE principles for narrative synthesis, with study design and risk of bias considered in the assessment.
Resistant Pathogens
The review highlights Staphylococcus aureus, including MRSA, and resistant Gram-negative organisms as important contributors to treatment difficulty. Limited microbiology capacity, unregulated antibiotic sales, adherence challenges and weak prescribing oversight were identified as barriers to effective antimicrobial stewardship.
Local Antibiotic Delivery
The review describes locally produced antibiotic-impregnated polymethylmethacrylate beads and biodegradable or locally adaptable carriers as promising low-resource strategies, while noting that evidence for regional scalability and long-term standardization remains limited.
Simulation-Based Training
Simulation-based training is discussed as a potentially useful adjunct for improving infection prevention knowledge, adherence to aseptic practice, hand hygiene and learner confidence, although larger-scale evidence with patient-level outcomes remains limited.
Contributor Statement
Emmanuel A. Owolabi conceived and designed the study, developed the methodology, wrote the original draft, supervised the project and led review, editing and project administration. Priscilla O. Bakare and Winifred O. Fagbenro conducted the literature search and contributed to manuscript review and editing.
Conflict of Interest & Funding
Conflict of Interest:
No conflict of interest.
Funding:
No funding received by the authors.
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Licence & Article Record
This article is published by
The Operating Room Global Journal (TORGJ)
under the Creative Commons Attribution
4.0 International licence (CC BY 4.0).
Persistent DOI:
10.64573/torgj2507002
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